Use of ambulatory electrocardiographic (Holter) monitoring

Article Abstract:

An electrocardiogram (ECG) is a recording of the electrical activity of the heart that reveals the conduction of the heart beat through the various parts of the heart. The ECG is of value for diagnosing abnormal heart rhythms (arrhythmias) or heart damage. When blood flow to the heart decreases (ischemia), as in a heart attack, one segment of the ECG called the S-T segment is changed and reflects the heart damage. In the 1960s, a portable ECG machine called a Holter monitor was developed. It is worn by the patient during the day and night, and records the patient's ECG for up to 24 hours. It is of value for obtaining a record of heart rhythm that would not be discovered by a conventional ECG of only a few minutes duration. This study evaluated the effectiveness of the Holter monitor and developed guidelines for its use. The Holter ECG results can be highly variable and caution should be used in their interpretation. This type of heart monitoring can provide useful information about the prognosis of a patient after a heart attack, especially when combined with a diary of the patient's daily activities. This allows the timing of the patient's activities to be compared with the development of any arrhythmia. If the patient does not have daily symptoms, then the usefulness of this type of ECG monitoring is questionable. The Holter monitor can also be used to assess the effectiveness of drugs that prevent heart rhythm disturbances (anti-arrhythmic drugs), but data about its effectiveness in this and other conditions is sparse. Since results concerning S-T segment changes can be highly variable, the presence or absence of heart blood vessel disease cannot be accurately determined. Although the Holter monitor can provide useful information about the diagnosis and prognosis of certain heart conditions and the possible therapeutic effectiveness of anti-arrhythmic drugs, better, more accurate methods exist to obtain such information. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Cardiac event recorders yield more diagnoses and are more cost-effective then 48-hour Holter monitoring in patients with palpitations: a controlled clinical trial

Article Abstract:

Event monitors may be more useful and cost-effective in detecting abnormal heart rhythms as compared to 48-hour Holter monitors. Patients place the hand-held event monitor on their chest during 30 seconds of symptoms and later transmit the recording over the telephone for evaluation. Researchers compared the cost-effectiveness and ability to detect abnormal heart rhythms using 48-hour Holter monitoring and event monitoring in 43 patients reporting a history of irregular heartbeat. Twenty-nine of the 43 patients (67%) transmitted readable recordings during symptoms with the event monitor over a 6-month time period. The event monitor readings identified 8 (19%) patients with significant abnormal heart rhythms. The 48-hour Holter monitors provided useful recordings for only one-third of the patients and identified no patients with significant abnormal heart rhythms. The event monitors were also more cost-effective than the Holter monitors.

Heart, Palpitations

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The Evolving Role of Ambulatory Arrhythmia Monitoring in General Clinical Practice

Article Abstract:

Ambulatory electrocardiographic monitors may be useful in detecting arrhythmias. These devices are monitors that are worn on the body with packs that can be carried around. An analysis of studies in the medical literature show that they are effective in diagnosing arrhythmias, especially the transtelephonic continuous-loop event recorders. They can also be used to evaluate anti-arrhythmia drugs. It is still not clear whether they can help patients at risk of sudden death.

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