Superiority of 24-hour outpatient monitoring over multi-stage exercise testing for the evaluation of syncope

J Electrocardiol. 1979 Jan;12(1):103-8. doi: 10.1016/s0022-0736(79)80052-7.


Twenty-four hour outpatient monitoring was compared with maximum multi-stage Treadmill exercise testing for the detection of dysrhythmias producing syncope or near syncope in 119 patients. All patients had cardiovascular disorders; only 21% had coronary artery disease. Patients with obvious cause of syncope and/or significant dysrhythmias by resting electrocardiograms (ECGs) were excluded. A significant dysrhythmia was found which was considered the probable cause of syncope or pre-syncope in 76 patients (64%). A non-cardiac cause was found in tachycardia, exercise testing identified only patients with complex ventricular dysrhythmias and missed 64% of these. Overall, dysrhythmias were found by ambulatory monitoring alone in 63 patients, by exercise testing alone in only three, and by both in 10. It is concluded that: 1) in the majority of patients with syncope or pre-syncope suspected to be of a cardiac origin, a dysrhythmia can be found; 2) ambulatory monitoring is far superior to exercise testing for detection of dysrhythmias; 3) exercise testing increases the yield for complex ventricular dysrhythmias.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Ambulatory Care
  • Arrhythmias, Cardiac / diagnosis*
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / diagnosis
  • Coronary Disease / diagnosis
  • Exercise Test*
  • Female
  • Heart Diseases / diagnosis
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Physiologic / instrumentation*
  • Syncope / etiology*
  • Tachycardia / diagnosis