Relationship between 24- hour Holter variables, chest discomfort and syncope: Does age matter?

Abstract

One hundred and forty four ambulatory, non-emergent human subjects from 20-88 years of age were investigated following<br />routine 24 hour Holter monitoring referred by primary and tertiary care centers primarily for evaluation of palpitations<br />and syncope. The patients were grouped into 3 different age categories: A) 20-59 years of age (16%), B) 60-69 years<br />of age (26.4%) and C) > 70 years of age (57.6%). Heart rate profile, RR intervals, symptoms, frequency of premature<br />supra ventricular and ventricular complexes were registered. The data show that though the occurrence and frequency<br />of premature atrial and ventricular contractions over a period of 24 hours did not differ between the groups, the younger<br />subjects documented more subjective discomforts during the Holter monitoring. Extra-systoles in excess of 1000 beats / 24<br />hour occured incessantly throughout the registration. Patients with syncope and those without did not differ as regards the<br />Holter variables. However, subjects with atrial fibrillation had acceptable rate control and had significantly lower incidence<br />of syncope than those with sinus rhythm. The findings suggest that in a county setting, Holter monitoring for evaluation of<br />syncope may not be the first hand mode of investigation in a non emergent setting. On the contrary, the modality appears<br />to be valuable for monitoring patients with atrial fibrillation. Even mild symptoms in the elderly population may warrant closer<br />clinical follow up to prevent cardiac events and/or syncope leading to serious physical injury.