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

• Published in: The American journal of cardiology 2010-09, Vol.106 (5), p.677-681
• Main Authors: Pastor-Pérez, Francisco J., MD, Manzano-Fernández, Sergio, MD, Goya-Esteban, Rebeca, MSc, Pascual-Figal, Domingo A., MD, PhD, Barquero-Pérez, Oscar, MSc, Rojo-Álvarez, Jose Luis, MEng, PhD, Martinez-Espejo, Maria Dolores Martinez, MD, Chavarri, Mariano Valdés, MD, PhD, García-Alberola, Arcadio, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - epidemiology; Biological and medical sciences; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiology; Cardiology. Vascular system; Cardiovascular; Cohort Studies; Electrocardiography, Ambulatory - methods; Female; Heart; Heart failure; Heart Failure - diagnosis; Heart Failure - etiology; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Male; Medical sciences; Middle Aged; Monitoring systems; Myocardial Ischemia - complications; Myocardial Ischemia - diagnosis; Myocardial Ischemia - physiopathology; Myocarditis. Cardiomyopathies; Predictive Value of Tests; Prevalence; Questionnaires; Stroke Volume; Time Factors; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2010.04.027

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-terminal–pro-brain natriuretic peptide levels