Holter and pacemaker diagnostics

Abstract

The introduction of Holter monitoring almost 30 years ago was a major advance with respect to arrhythmia diagnosis and management, permitting medical personnel to identify transient arrhythmias, correlate symptoms with a multiplicity of rhythm disorders, and assess the effectiveness of any therapeutic interventions. Holter studies have also been used to evaluate pacing system function, often identifying a multiplicity of abnormalities, commonly transient and commonly not associated with symptoms. Thus, some physicians have recommended that Holter studies should be a routine component of a pacing system evaluation [1–4]. The Holter study commonly provides a variety of different formats for the same data. An individual study may comprise a continuous display of the rhythm at a compressed format, often showing 1 h of rhythm on a single page, an expansion of the rhythm for symptomatic events, counts of the number of ectopic beats which may be further separated by morphology and rhythm sequences, as well as heart rate trends. For all the elegance of the current Holter recordings, knowledgeable personnel need to review the final result and often relabel individual complexes which are misinterpreted by the automatic recognition algorithms.