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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2017;148:479" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Diagnostic and prognostic performance of 24-hour Holter in patients with unrecorded syncope" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "479" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Rendimiento diagnóstico y pronóstico del Holter de 24 horas en pacientes con síncope no aclarado" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Leydimar Anmad Shihadeh, Javier Lorenzo-González, Diego Fernández-Rodríguez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Leydimar Anmad" "apellidos" => "Shihadeh" ] 1 => array:2 [ "nombre" => "Javier" "apellidos" => "Lorenzo-González" ] 2 => array:2 [ "nombre" => "Diego" "apellidos" => "Fernández-Rodríguez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775317300945" "doi" => "10.1016/j.medcli.2016.12.047" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775317300945?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020617303108?idApp=UINPBA00004N" "url" => "/23870206/0000014800000010/v1_201706100114/S2387020617303108/v1_201706100114/en/main.assets" ] ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Reply" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "480" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Cayetana Barbeito-Caamaño, Alberto Bouzas-Mosquera, Gabriel Sánchez-Fernández" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Cayetana" "apellidos" => "Barbeito-Caamaño" ] 1 => array:4 [ "nombre" => "Alberto" "apellidos" => "Bouzas-Mosquera" "email" => array:1 [ 0 => "alberto.bouzas.mosquera@sergas.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "Gabriel" "apellidos" => "Sánchez-Fernández" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We appreciate the interest and comments from Anmad Shihadeh et al. about our article.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Holter monitoring is a very important tool in the diagnosis of syncope. While we recognise that this is a non-invasive test that allows detection of potentially serious arrhythmias, these features are precisely what make it so prone to its overuse, even though in most cases of syncope there is no underlying arrhythmic cause, which in turn translates into a significant cost per diagnosis.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Our article is mainly focused on the evaluation of diagnostic performance of 24<span class="elsevierStyleHsp" style=""></span>h Holter monitoring in patients with syncope in terms of probability of positive findings; in this regard, we note that 96% of patients referred to Holter in our study showed no finding that we considered “diagnostic”, and 92.9% did not have any abnormalities potentially associated with an arrhythmic cause. This led us to the conclusion that the diagnostic performance of Holter monitoring in unselected patients with syncope, at least in our sample, was relatively low.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Furthermore, we analysed the ability of Holter monitoring for predicting the combined event of death or device implantation (pacemaker or defibrillator) during one year of follow up. Although the proportion of patients that met this prognostic endpoint was 4 times higher in the group of those who had diagnostic findings during Holter monitoring, the interpretation of results performed by Anmad Shihadeh et al. is subject to significant limitations. It should be taken into account that this endpoint cannot be considered a true <span class="elsevierStyleItalic">gold standard</span>, also, that non-arrhythmic causes of death were not excluded and that various confounders (including age) may have affected the association between the presence of findings in Holter and mortality. In addition, the decision to implant a device may have been influenced by the result of Holter monitoring (“self-fulfilling prophecy”). However, two-thirds of patients requiring a device implant within the year following Holter monitoring did not have any abnormal finding in that same.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Our goal was not to belittle the role of 24<span class="elsevierStyleHsp" style=""></span>h Holter-ECG in the diagnosis of syncope of unknown origin. However, our results highlight the need to seek strategies<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> that allow a more efficient selection of both patients (depending on the pre-test probability of the arrhythmic aetiology of syncope) and duration of electrocardiographic monitoring, the implementation of which we believe would help increase the diagnostic performance of the said test<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> without compromising the safety of these patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-01-18" "fechaAceptado" => "2017-02-09" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Barbeito-Caamaño C, Bouzas-Mosquera A, Sánchez-Fernández G. Respuesta. Med Clin (Barc). 2017;148:480.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar1005">See related content at <span class="elsevierStyleInterRef" id="intr1005" href="doi:10.1016/j.medcle.2016.12.071">doi:10.1016/j.medcle.2016.12.071</span>.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rendimiento diagnóstico y pronóstico del registro Holter de 24 horas en pacientes con síncope" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Barbeito-Caamaño" 1 => "G. Sánchez-Fernández" 2 => "A. Bouzas-Mosquera" 3 => "F.J. Broullón" 4 => "N. Álvarez-García" 5 => "J.M. 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