Contribution of Holter ECG to the diagnosis of palpitations in Brazzaville (Congo)

Objective To determine the prevalence and the nature of the rhythmic disorders during palpitations. Methods It was about a cross-sectional study, descriptive, conducted to Brazzaville between January 2012 and December 2016. The study related to a consecutive series of 530 patients having carried out 24 h Holter ECG for assessment of palpitations. The sociodemographic parameters of the patients were collected, and the principal indexed rhythmic anomalies. The Lown classification made it possible to evaluate the degree of gravity of the ventricular ectopic beats (VEB) into benign and complex or malignant. Results There were 225 men (42.5%) and 305 women (57.5%), old on average of 48.7 ± 13.2 years, without difference between the two sexes (49.7 ± 14.6 vs 50.9 ± 13.7 years; P  = 0.311). The Holter ECG, prescribed by a cardiologist in 476 cases (89.8%) and by a general practitioner in 54 cases (10.2%), was normal in 360 cases (68%) and pathological in 170 cases (32%). The mean average heart rate (HR) was 76.8 ± 10.7 bpm, the mean minimum HR was 56.5 ± 9.4 bpm, and the mean maximum HR was 116.3 ± 13.1 bpm. The principal recorded anomalies consisted into VEB ( n  = 136), supraventricular ectopic beats ( n  = 27), paroxysmal atrial fibrillation ( n  = 9), non-sustained ventricular tachycardia ( n  = 4), sustained ventricular tachycardia and nodal tachycardia in two cases each one. The VEB were isolated ( n  = 125), couplets ( n  = 38), triplets ( n  = 14), and bigeminy ( n  = 65). One noted salvos of VEB in 11 cases (8.1%). The VEB were benign in 125 cases (92%), and complex or malignant in 11 cases (8%). Conclusions This study underlines the interest of 24 h Holter ECG in the diagnosis of palpitations. If the anomalies frequently in question seem benign, others more serious are to be feared in spite of their relative scarcity. Such is the case of atrial fibrillation and the malignant ventricular arrhythmias.