Open Access Highly Accessed Research article

Intermittent short ECG recording is more effective than 24-hour Holter ECG in detection of arrhythmias

Tijn Hendrikx1*, Mårten Rosenqvist2, Per Wester3, Herbert Sandström1 and Rolf Hörnsten4

Author Affiliations

1 Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87 Umeå, Sweden

2 Department of Clinical Sciences, Danderyds Sjukhus, Karolinska Institutet, SE-182 88 Stockholm, Sweden

3 Umeå Stroke Center, Department of Public Health and Clinical Medicine, Umeå University, SE-90187 Umeå, Sweden

4 Clinical Physiology, Heart Centre and Department of Surgical and Perioperative Science, Umeå University, SE-901 87 Umeå, Sweden

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BMC Cardiovascular Disorders 2014, 14:41  doi:10.1186/1471-2261-14-41

Published: 1 April 2014



Many patients report symptoms of palpitations or dizziness/presyncope. These patients are often referred for 24-hour Holter ECG, although the sensitivity for detecting relevant arrhythmias is comparatively low. Intermittent short ECG recording over a longer time period might be a convenient and more sensitive alternative. The objective of this study is to compare the efficacy of 24-hour Holter ECG with intermittent short ECG recording over four weeks to detect relevant arrhythmias in patients with palpitations or dizziness/presyncope.


Design: prospective, observational, cross-sectional study. Setting: Clinical Physiology, University Hospital. Patients: 108 consecutive patients referred for ambiguous palpitations or dizziness/presyncope. Interventions: All individuals underwent a 24-hour Holter ECG and additionally registered 30-second handheld ECG (Zenicor EKG® thumb) recordings at home, twice daily and when having cardiac symptoms, during 28 days. Main outcome measures: Significant arrhythmias: atrial fibrillation (AF), paroxysmal supraventricular tachycardia (PSVT), atrioventricular (AV) block II–III, sinus arrest (SA), wide complex tachycardia (WCT).


95 patients, 42 men and 53 women with a mean age of 54.1 years, completed registrations. Analysis of Holter registrations showed atrial fibrillation (AF) in two patients and atrioventricular (AV) block II in one patient (= 3.2% relevant arrhythmias [95% CI 1.1–8.9]). Intermittent handheld ECG detected nine patients with AF, three with paroxysmal supraventricular tachycardia (PSVT) and one with AV-block-II (= 13.7% relevant arrhythmias [95% CI 8.2–22.0]). There was a significant difference between the two methods in favour of intermittent ECG with regard to the ability to detect relevant arrhythmias (P = 0.0094). With Holter ECG, no symptoms were registered during any of the detected arrhythmias. With intermittent ECG, symptoms were registered during half of the arrhythmia episodes.


Intermittent short ECG recording during four weeks is more effective in detecting AF and PSVT in patients with ambiguous symptoms arousing suspicions of arrhythmia than 24-hour Holter ECG.

Arrhythmias; Atrial fibrillation; Electrocardiography; Holter ECG; Intermittent ECG