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Continuous ambulatory electrocardiography in elderly people
EDITOR,--Mayer Bassan1 did not read our article carefully.2 We did not recommend routine Holter monitoring for elderly people to stratify their risk of cardiac death. That would be, as Bassan writes, the height of folly. Instead we recommended further evaluation of patients in whom monitoring performed for clinical reasons shows abnormal findings (described in our paper). As we wrote, the benefit of managing silent ischaemia in elderly people is unclear. Nevertheless, if silent ischaemia is diagnosed it is clinically and ethically accepted, even in elderly patients, that risk factors should be controlled and treatment with aspirin and even ß blockers considered. Specific treatment of the marker, arrhythmia, would be unwise and certainly ineffective. An important question is whether these markers are also valid in middle aged people.
Bassan argues that the markers were defined arbitrarily. This is not true. All clinically relevant arrhythmias shown by Holter monitoring were included in
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