What is the role of ambulatory ECG (Holter) monitoring in the workup of sinus node dysfunction (SND)?

Updated: Nov 30, 2018
  • Author: Bharat K Kantharia, MD, FRCP, FAHA, FACC, FESC, FHRS; Chief Editor: Mikhael F El-Chami, MD  more...
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For patients with clinically suspected sinus node dysfunction (SND) in whom the initial electrocardiogram (ECG) and monitoring are not diagnostic, ambulatory ECG monitoring or long-term event monitoring (eg, 7 or 30 days) is useful in the assessment of SND [30]  and for correlation with symptoms. 

The specificity of a direct observation of spontaneous (ie, not provoked by an electrophysiologic [EP] study) SND is 100%, and an EP study is not required. Therefore, cardiac monitoring, rather than EP study, is the method of choice to assess SND.

A 24-hour Holter study also has the advantage of revealing whether SND produces symptoms such as dizziness, presyncope, or syncope; these cannot be determined during an EP study, because the patient is heavily sedated. Therefore, a 24-hour Holter study can help decide if pacemaker therapy is required.

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