Assessment of transient or paroxysmal cardiac arrhythmias.
Evaluation of various symptoms (e.g., dizziness, syncope, palpitations); correlation with actual arrhythmias.
Diagnosis of transient myocardial ischemia; evaluation of anti-arrhythmic drug therapy and artificial pacemaker function.
In interpretation of the Holter monitor ECG, the basic cardiac rhythm should be first described.
Any cardiac arrhythmia detected by the Holter monitor ECG should be described in relation to the patient’s symptoms and physical activities.
When any ischemic change occurs on the Holter monitor ECG, the ECG finding should be correlated with the patient’s complaint (particularly chest pain) and physical activities.
When any cardiac arrhythmia is detected on the Holter monitor ECG, it should be mentioned whether a given arrhythmia is clinically significant or insignificant.
At present, the Holter monitor ECG equipment has the capability to record the ECG for 24 hours, but the old models can record only 10 or 12 hours.
A diary card must be completed by the patient, and detailed descriptions regarding symptoms in relation to the physical activities must be given. A recording of the precise time of each event is essential.
Newer models have a capability of recording 2 channels (2 ECG leads) but older models can record only one ECG lead.
The Holter monitor ECG is particularly useful for the diagnosis of sick sinus syndrome (SSS).
The most common complaints which require the Holter monitor ECG are dizziness or episodes of fainting spells.
The common manifestations of SSS include periods of marked sinus bradycardia, sinus arrest, S-A block, A-V junctional escape rhythm and atrial flutter or fibrillation with advanced A-V block.
At present, the most common indication for permanent artificial pacemaker implantation is SSS.
Holter monitor ECG is extremely important to document advanced bilateral bundle branch block (BBBB) in order to determine the indication vs. non-indication of permanent artificial pacemaker.
Brady-tachyarrhythmia syndrome (BTS) is often documented by the Holter monitor ECG, and BTS almost always requires permanent pacemaker implantation.
SSS is the most common underlying disorder to produce BTS.
Holter monitor ECG is very essential to document paroxysmal tachyarrhythmia in the Wolff-Parkinson-White (WPW) syndrome, because the rapid heart action in this syndrome is often transient.
The efficacy of digitalis for atrial fibrillation is best evaluated by the Holter monitor ECG to correlate with the patient’s activity, because well-controlled ventricular rate at rest may accelerate markedly during various physical activities. Under this circumstance, the dosage of digitalis may be increased or additional drug such as propranolol (Inderal) may be prescribed.
Various artifacts must be carefully searched in order to avoid possible misinterpretation of the artifact-induced ECG findings as true cardiac arrhythmias.
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