SPC365

Diagnostic yield of 24-hour Holter monitoring in nonagenarians – insights from a single-center cohort

Session: Sessão de Posters 03 - Arritmias cardíacas e dispositivos percutâneos no risco cardioembólico
Speaker: Adriana da Fonseca Vazão

Congress: CPC 2024
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.6 Device Therapy - Other
Session Type: Cartazes
FP Number: ---
Authors: Adriana Vazão; André Martins; Carolina Gonçalves; Mariana Carvalho; Margarida Cabral; João Carvalho; João Morais
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">Introduction:</span></span></span></strong>&nbsp;<span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">With increasing life expectancy, the prevalence of very old individuals in clinical practice is rising. Despite this, there is a paucity of data regarding diagnostic performance of 24-hour Holter (24-H) monitoring in those patients (pts)<strong><span style="font-family:&quot;PT Serif&quot;,serif">.</span></strong><strong>&nbsp;</strong></span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">Objective:</span></span></span></strong><strong>&nbsp;</strong><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">Evaluate the diagnostic yield of 24-H&nbsp;monitoring in nonagenarians.&nbsp;</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">Methods:</span></span></span></strong><strong>&nbsp;</strong><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">Single-center retrospective cohort study of<strong>&nbsp;</strong>pts with age &ge;90yrs&nbsp;who underwent 24-H monitoring (Oct&nbsp;2014-Nov&nbsp;2022). Data on baseline characteristics, electrocardiography and outcomes (1-year all-cause mortality, cardiovascular (CV) mortality, urgent pacemaker (PM) implantation) was&nbsp;recorded. 24-H positive findings were defined: sinus node disease (SND) (symptomatic sinus pause &gt;2.5s; junctional rhythm); atrioventricular (AV) node disease (type 2 2<sup>nd</sup>&nbsp;degree AV block; high-grade AV block; 3<sup>rd</sup>&nbsp;degree AV block); atrial fibrillation (AF) (episode with duration &gt;30s); slow AF (mean ventricular rate &lt;50/min;&nbsp;symptomatic ventricular pause &gt;3s; asymptomatic ventricular pause &gt;6s)</span></span></span><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">. </span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">Results:</span></span></span></strong><strong>&nbsp;</strong><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">204 exams from 181 pts were analyzed (median 91 years, 55% male). Structural heart disease was documented in 43% of pts, mainly hypertensive heart disease (56%). Electrocardiographic features were sinus rhythm (68%), bundle branch block (34%) and median corrected QT interval 435ms (IQR 390-480).&nbsp;Indications for Holter were&nbsp;systematic stroke evaluation (40%), syncope (17%), monitoring of AF rate control (10%), evaluation of asymptomatic bradycardia (8%), monitoring of premature atrial/ventricular contractions (5%), palpitations (3%) and arrythmia risk stratification in cardiomyopathy (3%) (graphic 1).&nbsp;Positive findings were observed in 29% of syncope cases [AV node disease (40%), SND (40%), and slow AF (20%)] and 4pts (40%) were referred for PM implantation.&nbsp;Regarding palpitations, 2 pts had a positive study (29% diagnostic yield), 1 with AV node disease (referred for PM implantation) and 1&nbsp;with de novo AF.&nbsp;Regarding stroke evaluation, the diagnostic yield was 26%, the majority with de novo AF (76%). Of those 50% were anticoagulated after this finding.&nbsp;Overall, 24-H monitoring changed therapeutic attitudes in 26pts(14%). &nbsp;One-year all-cause mortality was 23%, CV mortality was 3% and 4% required urgent PM implantation.&nbsp;</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">Conclusion:</span></span></span></strong><strong>&nbsp;</strong><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">In this population, 24-H monitoring remained a valuable non-invasive test for nonagenarians&nbsp;and lead to changes in therapeutic management in 14% of pts. As expected one-year mortality was high, mainly due to non-CV causes.</span></span></span></span></span></span></p>