Written by Denrick Cooper
Spoon Feed
Short-term ambulatory cardiac monitoring has diagnostic usefulness, although limited, in patients discharged from the emergency department.
Rhythm nation – does short-term monitoring catch the beat?
Identifying arrhythmias at the time of symptoms is critical for diagnosing causes of syncope, palpitations, or dizziness. This makes both the choice and duration of ambulatory cardiac monitoring essential for accurate diagnosis and management in patients discharged from the emergency department.
This was a retrospective chart review of 491 adults discharged from the ED with symptoms suggestive of arrhythmia and 24-48 hour Holter monitoring. Overall diagnostic yield was 68.2% (95%CI 63.9-72.3), defined broadly as any result impacting diagnosis, management, or follow-up. No significant difference was found between 24-hour (66.9%) and 48-hour (70.7%) monitoring (p=0.39). Significant arrhythmias were detected in 37.3%.
The study has key limitations. A broad definition of diagnostic yield may overstate the clinical usefulness. Also, the changes in management with a positive Holter monitor were not reported.
How does this change my practice?
It’s great to see technology advancing with more reliable patch monitors out there, but I don’t think this study fully challenges what we know: longer monitoring can give a clearer picture. The study’s broad definition of “clinically useful” seemed to inflate the results. While I’m not opposed to short-term monitoring, and a 24-48 hour Holter can be useful, it has a limited capacity. It’s effective for catching arrhythmias in low-risk patients, but I always stress the importance of follow-up with cardiology for further evaluation and possibly extended monitoring if feasible.
Sources
Diagnostic yield of 24 to 48-hour ambulatory cardiac monitoring in discharged emergency department patients. Am J Emerg Med. 2025 Apr 7;93:170-175. doi: 10.1016/j.ajem.2025.04.012. Epub ahead of print. PMID: 40215590
