Ruolo diagnostico dell'elettrocardiogramma dinamico (Holter) nella diagnosi di sincope nei pazienti anziani

Objective. Syncope is very common in the elderly and is associated with increased morbility and mortality. Arrhythmic causes have a greater incidence in the elderly. The diagnostic role of ECG monitoring (Holter) is still matter of debate. Materials and methods. Therefore, we retrospectively studied 672 patients discharged with diagnosis of syncope from the Department of Internal Medicine of the University of Brescia along 46 months (01.01.2001 - 31.10.2004). Results. 505 patients underwent 24 hours ECG monitoring (75% of whole) of whom 152 aged less than 65 years and 353 more than 65 years. In the former group in only 4 subjects a significant bradyarrythymia was found, potentially related to syncope and implying the implantation of permanent pace-maker; in the elderly group as many as 38 patients (10,8%) underwent the implantation of the device. Further, significantly greater was the number of episodes of Non Substained Ventricular Tachycardia and Supraventricular Tachycardia in the elderly group. Conclusions. Our study shows a still extensive (75%) use of ECG monitoring in the diagnostic iter of syncope in an Internal Medicine Department, even if the European Guidelines are more restrictive. Nothwithstanding this large and extensive use of the method, in the elderly group only, we found a significant incidence of arrhythmias satisfying the criteria for pace-maker implantation. These findings suggest that, in the elderly patients, a too restrictive strategy regarding the ECG monitoring indications might be associated with a loss of a significant number of arrhythmic events of potentially relevant clinical implications. Clearly, the problem is complex and deserves further evaluation.