Diagnosis of occult arrhythmias by Holter electrocardiography

Bleifer, Selvyn B.; Bleifer, Daniel J.; Hansmann, Douglas R.; Sheppard, Joseph J.; Karpman, Harold L.

doi:10.1016/0033-0620(74)90019-x

Cited by 114 publications

(14 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The magnitude of this ventricular fibrillation associated with ischaemia problem has led to repeated attempts to define (Lown and Wolf, 1971;Schaffer and Cobb, 1975), factors that might predict those patients at greatest since most findings at necropsy show evidence of risk, so that the prophylactic use of long-term antiarrhythmic agents could be considered. The presence of ventricular premature beats in patients FWork sponsored in part by a grant from The National Heart with coronary artery disease appears to be one such Holter continuous electrocardiogram monitoring (Holter, 1957) has been of particular value in the assessment of arrhythmias in ambulatory patients (Bleifer et al, 1974). A standard 12 lead electrocardiogram tracing over 1 minute detects ventricular premature beats in 8 per cent of patients with coronary artery disease, while 12 hours of Holter monitoring in the same group shows ventricular premature beats in 62 per cent of patients (Lown and Wolf, 1971).…”

mentioning

confidence: 99%

Incidence of ventricular arrhythmias in first year after myocardial infarction.

Federman¹,

Whitford²,

Anderson³

et al. 1978

Heart

View full text Add to dashboard Cite

SUMMARY The incidence of ventricular arrhythmias in the first year after acute myocardial infarction was studied prospectively using 24-hour Holter electrocardiogram tape monitoring. Of 108 patients who entered the trial, 74 completed the 12 months of study. Patients were initially studied at 2 weeks after infarction then at 3-monthly intervals. Ventricular premature beats were observed in 80 per cent of studies, with these arrhythmias occurring in 57 per cent of the total hours studied. 'Significant' ventricular arrhythmias defined as ventricular premature beats greater than 1 in 10 beats, multifocal ventricular premature beats, bigeminy or trigeminy, salvos (2 or 3 consecutive ventricular premature beats), R on T, or ventricular tachycardia (4 or more ventricular premature beats), occurred in 54 per cent of studies, with these arrhythmias occurring in 40 per cent of the total hours studied. The incidence of ventricular arrhytbmias remained fairly constant for each 3-month period while the percentage of total studied hours for which ventricular arrhythmias occurred was significantly higher after the entry study at 2 weeks.The incidence of ventricular arrhythmias was significantly higher in patients with inferior or posterior infarction after the entry study compared with those with anterior infarction (P < 04005). Patients who had cardiac failure in the coronary care unit or a peak serum aspartate anminotransferase > 200 IU/l had a higher long-term incidence of ventricular arrhythmias (P < 0.01).Four deaths occurred during the study. In all cases ventricular premature beats were observed on at least 1 period of study, with significant ventricular premature beats in 2 of the 3 patients who died suddenly.A control group of 21 normal subjects had a random 24-hour Holter study and were found to have a significantly lower incidence of ventricular arrhythmias when compared with thepost-infarctiongroup. Ventricular premature beats were observed in 48 per cent of cases (P < 04005) for 28 per cent of the total hours studied (P < 04025) and significant ventricular arrhythmias in 19 per cent of cases (P < 04005) for 35 per cent of the total hours studied.The standard electrocardiogram proved to be a poor indicator of the true incidence of ventricular premature beats found on 24-hour Holter monitoring, with 75 per cent of patients having ventricular arrhythmias and 43 per cent showing 'significant' ventricular arrhythmias when all standard electrocardiograms showed no ventricular premature beats.In patients with coronary artery disease 60 per significant coronary artery disease without evidence cent of the deaths are sudden (Kuller, 1966). of recent infarction (Schwartz and Walsh, 1971; The major mechanism of death is thought to be Schaffer and Cobb, 1975). The magnitude of this ventricular fibrillation associated with ischaemia problem has led to repeated attempts to define (Lown and Wolf, 1971;Schaffer and Cobb, 1975), factors that might predict those patients at greatest since most findings at necropsy show evidence of...

show abstract

mentioning

confidence: 99%

Incidence of ventricular arrhythmias in first year after myocardial infarction.

Federman¹,

Whitford²,

Anderson³

et al. 1978

Heart

View full text Add to dashboard Cite

show abstract

“…arrhythmia prevalence in nonischemic disease, and to studies assessing specific drug interventions using ambulatory electrocardio graphic recording. Alternative perspectives arc available in other recent reviews and texts [11][12][13][14][15][16],…”

Section: Introductionmentioning

confidence: 99%

Clinical Applications of Ambulatory Electrocardiography

Kligfield

1984

Cardiology

View full text Add to dashboard Cite

“…The most sensitive investigation, where the diagnosis has not already been confirmed by routine electrocardiograms, is continuous ambulatory electrocardiographic recording (12,25,27,29,32,39). This procedure, repeated if necessary, has proved valuable in the diagnosis of symptoms related to r~latively infrequent episodes of bradycardia (6,31) or tachycardia (6).…”

Section: Discussionmentioning

confidence: 99%

Atrial bigeminy with block associated with bradycardia and paroxysmal atrial fibrillation — An important variant of the tachycardia‐bradycardia syndrome

Washington

Spurrell

1979

Clinical Cardiology

View full text Add to dashboard Cite

Summary:Serial 2-channel 24 h dynamic ECGs in 7 patients who were referred with the "tachy-brady" syndrome for consideration for permanent cardiac pacing revealed:1. atrial premature beats (APBs) which were conducted to the ventricles normally or aberrantly; 2. intermittent atrial bigeminy with block towards the ventricles (this rhythm mimicked sinus bradycardia with ventricular rates of 38-45 beats/min and the ectopic P waves were visible on only one of the ECG channels); 3. paroxysms of atrial fibrillation initiated by closely coupled APBs.These findings suggested that both the ventricular bradycardia and the atrial fibrillation were caused by frequent APBs and that pacing therapy was unnecessary. Disopyramide was given to 5 patients resulting in suppression of the arrhythmia and relief of symptoms. In one patient there was spontaneous resolution and one patient refused treatment. This variant of the "tachy-brady" syndrome can be successfully treated by suppression of abnormal atrial impulse formation without recourse to pacemaker implantation.

show abstract

Diagnosis of occult arrhythmias by Holter electrocardiography

Cited by 114 publications

References 47 publications

Incidence of ventricular arrhythmias in first year after myocardial infarction.

Incidence of ventricular arrhythmias in first year after myocardial infarction.

Clinical Applications of Ambulatory Electrocardiography

Atrial bigeminy with block associated with bradycardia and paroxysmal atrial fibrillation — An important variant of the tachycardia‐bradycardia syndrome

Contact Info

Product

Resources

About