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Comparison of detection of arrhythmias in patients with chronic heart failure secondary to non-ischemic versus ischemic cardiomyopathy by 1 versus 7-day Holter monitoring

Abstract:

The purpose of this study was to compare the diagnostic sensitivity of 1-day Holter monitoring versus 7-day Holter monitoring (7DH) to detect atrial and ventricular arrhythmias in a population of stable patients with chronic heart failure and left ventricular dysfunction. Sixty-three consecutive stable patients with chronic heart failure with left ventricular ejection fractions ≤50% were included. Blood samples were obtained, the Minnesota Living With Heart Failure Questionnaire was administered, and echocardiography, 6-minute walk tests, and 7DH were performed at enrollment. The mean ejection fraction was 35.8 ± 9.8%, and the mean age was 55.5 ± 13.9 years. Seven-day Holter monitoring did not significantly increase the detection of nonsustained atrial tachycardia or atrial fibrillation. In contrast, the incidence of nonsustained ventricular tachycardia increased in nonischemic patients from 35.1% on day 1 to 54.1% on day 7 (p = 0.01). In ischemic patients, the sensitivity increased from 11.5% to 46.2% (p = 0.004). Two patients without nonsustained ventricular tachycardia on day 1 had episodes of 13 and 16 beats on days 3 and 6 of monitoring. In patients with left ventricular ejection fractions >35% and N-terminalpro-brain natriuretic peptide levels <1,000 pg/ml, no episodes of nonsustained ventricular tachycardia were detected on day 1 in nonischemic and ischemic patients, but 7DH detected 3 new patients in each group. In conclusion, 7DH clearly improves the detection and allows a better characterization of ventricular arrhythmic episodes but seems to be less useful for supraventricular events. © 2010 Elsevier Inc. All rights reserved.