Diagnostic and prognostic value of ambulatory electrographic monitoring in older patients.

OBJECTIVE: To review the use of ambulatory electrocardiographic monitoring in detecting transient cardiac arrhythmias and myocardial ischemia in older patients and to determine the significance of these findings in predicting future cardiac events. DATA SOURCES: Reports on ambulatory electrocardiographic monitoring's capabilities in the detection and quantification of arrhythmias and myocardial ischemia were identified by multiple searches on the MEDLINE database and citations from relevant articles. STUDY SELECTION: Studies that demonstrated good research methodology were reviewed. Review was limited to studies that used reel-to-reel or cassette recorders (not reel-time monitors). DATA EXTRACTION AND SYNTHESIS: Pertinent data were extracted from the studies, with specific emphasis on studies involving older patients. Prognostic findings were critically analyzed and compared between younger patients and older patients. Differences in prognoses younger patients with and without underlying heart disease were assessed.
CONCLUSION: Ambulatory electrocardiographic monitoring is a noninvasive procedure that is beneficial in stratifying older patients with heart disease into high and low risk groups for future cardiac events. The presence of complex ventricular arrhythmias or silent myocardial ischemia as documented on 24-hour monitoring, especially in combination with left ventricular dysfunction or left ventricular hypertrophy, is highly predictive of future cardiac events, including sudden cardiac death and total cardiac mortality. The use of preoperative, intraoperative, and postoperative electrocardiographic monitoring may also be beneficial in stratifying older surgical patients into high and low risks for postoperative cardiac events.