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

Continuous recording of cardiac rhythm over a period of 24-48 hour non-invasively using a digital device and subsequent computer software assisted electrocardiographic analysis (Holter ECg monitoring) plays a significant clinical role in the evaluation of arythmias in subjects with palpitations, subjective chest discomfort, as well as for evaluation of syncope. Holter electrocardiogram is also used to monitor the heart rate profile in patients with atrial fibrillation on antiarrhythmic medication to evaluate and monitor the effects of these medications. subjective discomfort, if related to documented arrhythmia, is clinically very useful when diagnosing these patients. However, a clear cut dissociation between subjective symptoms with or without evidence of significant arrhythmia is clinically useful, particularly in the community setting.1 In patients with syncope or near syncope without any identifiable cause or in patients with recurrent palpitation there is a class I recommendation for ambulatory Holter ECg monitoring.1 Despite the recommendation, the cause of syncope is difficult to find since it can occur infrequently but has a large impact on patients ́ quality of life.