Association between symptoms and frequency of arrhythmias on 24-hour Holter monitoring.

OBJECTIVE To determine association between patient's symptoms and incidence of arrhythmia on 24-hour electrocardiographic Holter monitoring. STUDY DESIGN A cross-sectional descriptive study. PLACE AND DURATION OF STUDY The Cardiology Department, Liaquat National Hospital, Karachi, from January to June 2007. METHODOLOGY Patients above 15 years of age, of either gender, referred for Holter monitoring with symptoms of palpitations, dizziness and syncope were evaluated for arrhythmia. The symptoms were documented by the patients in their symptom diaries (historical logs) during Holter monitoring. Patients who had permanent pacemaker implants were excluded. Descriptive statistics were used to calculate the frequencies and percentages of different symptoms, different arrhythmias were noted on Holter monitoring and the age of patients was noted. Chi-square test was applied to calculate p-values with significant at value less than 0.05. RESULTS The mean age of patients was 53.71 +/- 15.52 years. There were 54% females and 46% males. Eighty two percent had documented arrhythmias on their Holter monitoring reports. The complaints for which patients were referred included dizziness in 24%, palpitations in 61% and syncope in 15%. On analysis of the historical logs of patients only 64% had symptoms during Holter monitoring and 23% had concurrence of their symptoms with an arrhythmia. Patients who had sinus exit block (p=0.02) and sinus arrest (p=0.002) had significant association with arrhythmia. Twenty percent patients with dizziness, 50% patients with palpitations and 12% of patients who presented with syncope had documented arrhythmias. CONCLUSION Twenty four hour Holter monitoring is an important investigation for evaluation of patients with palpitation, dizziness and syncope. Arrhythmias were detected frequently in both symptomatic and asymptomatic patients. One must be careful to avoid attributing a symptom to an arrhythmia until a close temporal relationship is demonstrated.