Management of Cardiac Arrhythmias by Mark E. Josephson MD, Leonard I. Ganz MD (auth.), Leonard I.

By Mark E. Josephson MD, Leonard I. Ganz MD (auth.), Leonard I. Ganz MD (eds.)

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Am J Cardiol 1997;79:371–372. 14. Kinlay S, Leitch JW, Neil A, Chapman BL, Hardy DB, Fletcher PJ. Cardiac event recorders yield more diagnoses and are more cost-effective than 48-hour Holter monitoring in patients with palpitations. A controlled clinical trial. Ann Intern Med 1996;124:16–20. 15. DiMarco JP, Philbrick JT. Use of ambulatory electrocardiographic (Holter) monitoring. Ann Intern Med 1990;113:53–68. 16. Bass EB, Curtiss EI, Arena VC, et al. The duration of Holter monitoring in patients with syncope.

This benefit was entirely attributable to the use of ICDs. These studies, which demonstrate a clear benefit associated with the use of ICDs in the treatment of certain post-MI patients with left ventricular dysfunction, raise the question of whether all such patients should undergo routine ambulatory monitoring to screen for NSVT. Such monitoring would place an enormous burden on the health care system (28,30). It is not clear how many patients enrolled in MADIT and MUSTT were identified by routine ambulatory monitoring.

Note that in common AVNRT RP′ < P′R, while in uncommon AVNRT, RP′ > P′R. (Reproduced from Ganz LI, Friedman PL. Supraventricular tachycardia. N Engl J Med 1995;332:162–173. ) Fig. 5. Event monitor in patient with PSVT. An APD (arrow), conducted with a long PR interval, initiates tachycardia. This is characteristic of typical AVNRT. This arrhythmia tends to occur in the setting of digitalis toxicity or early after valve surgery; it is also seen rarely in the setting of acute myocardial infarction (MI).

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