Prognostic value of holter monitoring in asymptomatic elderly subjects with sinus rhythm

Elderly people, even if asymptomatic and in apparently good cardiovascular condition, have a high incidence of cardiovascular events. Prognostic markers by noninvasive procedures would therefore be desirable. The aim of this study was to evaluate the prognostic usefulness of Holter monitoring in this setting. Holter findings in 50 asymptomatic elderly subjects with sinus rhythm were correlated with major clinical cardiovascular events occurring during a 5-year follow-up period (16% incidence). No significant association was found with any baseline arrhythmia category, even complex arrhythmias such as unsustained ventricular tachycardia, which had a 10% baseline prevalence. On the other hand, cardiovascular events were correlated (P < .01) with the presence of silent ST-segment depression (8% baseline prevalence), which seems to have an unfavorable clinical significance, in elderly, as well as younger, people. Holter monitoring, because of the benignity of high-prevalence findings and the very low incidence of unfavorable events, has an overall limited prognostic usefulness in asymptomatic elderly subjects with sinus rhythm. In a cost-conscious medical environment, its use seems to be justified only in selected cases.