Holter Findings in Kumasi Palpitations
Within this selected specialist-clinic population, Holter monitoring documented a substantial burden of recorded rhythm and conduction findings, but the retrospective cross-sectional design and narrow eligibility criteria limit inference beyond the study setting.
> Research explainer: This briefing examines verified primary research published 63 days before the briefing date. It is not a same-day research update and does not provide medical advice.
Evidence
This research explainer examines a retrospective cross-sectional study of 495 adults who presented with palpitations and underwent 18–24-hour Holter ECG monitoring at a private specialist cardiac clinic in Kumasi, Ghana. The records covered 2010–2022. Eligibility required a normal initial resting 12-lead ECG or sinus arrhythmia, alongside available clinical and Holter-diary information. Two cardiologists independently re-analysed selected recordings and reconciled differing reports. [pmid:42376354]
Of the 495 participants, 223 (45.1%) had a study-defined significant arrhythmia. Frequent ectopic beats were reported in 159 participants (32.0%). The authors defined significant arrhythmia broadly: it included sinus tachycardia or bradycardia, supraventricular or ventricular ectopic beats at least 30 per hour, and specified rhythm or conduction abnormalities. [pmid:42376354]
Ectopic activity of any frequency was especially common in this selected group: supraventricular ectopic beats appeared in 483 participants (97.6%) and ventricular ectopic beats in 402 (81.2%). These figures describe any-frequency findings, whereas the 32.0% frequent-ectopy figure uses a higher threshold; the measures should therefore not be treated as interchangeable. [pmid:42376354]
The reported distribution also included non-sustained ventricular tachycardia in 5.5% of participants, atrial fibrillation in 1.8%, Mobitz II atrioventricular block in 2.2%, sinus pauses longer than two seconds in 14.9%, and sinoatrial node block or arrest in 2.8%. [pmid:42376354]
Analysis — What This Selected Cohort Shows
The central result is descriptive: among adults with palpitations who were referred for a short-duration Holter recording under these criteria, nearly half had a finding classified by the investigators as a significant arrhythmia. That result characterizes the clinic’s selected monitoring population, not all adults with palpitations or the general population in Kumasi or Ghana. [pmid:42376354]
The distinction between frequent ectopy and ectopy of any frequency is important for reading the findings. Nearly universal detection of supraventricular ectopic beats and common detection of ventricular ectopic beats coexisted with a smaller 32.0% group meeting the study’s frequent-ectopy classification. The data therefore support a description of recorded ectopic activity in this sample, while preserving the study’s thresholds and terminology. [pmid:42376354]
After adjustment for age, sex, and comorbidity, the investigators reported that significant arrhythmias were associated with advancing age. They also reported associations between frequent ectopic beats and advancing age and between frequent ectopic beats and heart failure. These are adjusted associations from observational records; they do not establish that age or heart failure caused the Holter findings. [pmid:42376354]
The study’s setting and workflow help explain its narrow interpretive reach. Participants were already at a private specialist cardiac center, had palpitations as the indication, and had a normal resting ECG or sinus arrhythmia before monitoring. A continuous recording lasting 18–24 hours can capture electrical activity not present during a resting tracing, but this study did not compare monitoring strategies or estimate diagnostic performance. [pmid:42376354]
Limitations
This was a retrospective, cross-sectional analysis, so it reports prevalence and associations rather than causes, future outcomes, or risk trajectories. [pmid:42376354]
The sample came from one private specialist center in Kumasi and included only adults with palpitations who met restrictive selection criteria. Results may not generalize to people without palpitations, to patients with other abnormal resting ECG findings, to other Ghanaian settings, or to broader populations. [pmid:42376354]
The data span 2010–2022 and therefore do not estimate incidence or prevalence for the briefing date. Holter recordings were limited to 18–24 hours, which also bounds what was observed during each recording period. [pmid:42376354]
Finally, the abstract gives an adjusted odds ratio of 11.022 for advancing age and significant arrhythmia while reporting a 95% confidence interval of 1.008–1.036. That apparent numerical inconsistency should be checked against the full study before interpreting that effect estimate quantitatively. [pmid:42376354]