There have been a considerable amount of discussions surrounding the benefits of short term vs. extended monitoring for patients. Factors have included the duration of the study, the type of monitoring (i.e. Holter, Event or MCT), patient comfort, patient compliance, amount of ECG data collected, etc. But recent studies have shown that extended Holter may ultimately prove to be the best option for monitoring certain patient populations.
In a study1 recently conducted, researchers evaluated a 72 hour Holter, 7 day Holter and 30 day intermittent single-lead ECG recordings in patients with cryptogenic ischemic stroke (CIS). Each patient enrolled in the study had already undergone a 24 hour Holter study which had shown no arrhythmias. Each patient was given a Holter monitor that would record up to 7 days as well as a handheld 30 day ECG recorder that would intermittently record data. Atrial fibrillation (AF), Supraventricular Tachycardia (SVT) (runs of >5 beats) as well as other arrhythmias were reviewed at 72 hours and 7 days for the Holter and at 30 days for the handheld device.
The results showed that the 72 hour Holter recording captured AF in 5.6% of patients and SVT in 25%. The 7 day Holter recording captured AF in 10% of patients and SVT in 37.5%. None of the patients’ symptoms correlated with the arrhythmia findings. The handheld patient activated recordings captured only 1 case of AF out of 3,531 strips.
The conclusion of this study was that the 7 day Holter outperformed the 72 hour Holter by detecting AF in 10% and supraventricular in every third of CIS patients who were non-symptomatic that had shown no arrhythmias in a previous 24 hour Holter study. The 30 day handheld patient activated monitor did not show diagnostic value in patients with CIS.
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1 https://www.degruyter.com/document/doi/10.1515/med-2020-0203/html