Holter monitoring

ECG Holter monitor, etc.) loaded into your clinical data management system, and you will want the specifications for those data as well. 

After acute PSVT is terminated, long-term preventive treatment is indicated if frequent episodes necessitate therapeutic intervention or if episodes are infrequent but severely symptomatic. Serial testing of antiarrhythmic agents can be evaluated in the ambulatory setting via ambulatory ECG recordings (Holter monitors) or telephonic transmissions of cardiac rhythm (event monitors) or by invasive electrophysiologic techniques in the laboratory. 

QT prolongation, recent acute Ml, uncompensated heart failure, cardiac arrhythmia). Discontinue treatment if the QT interval is over 500 msec. Patients who experience symptoms that may be associated with the occurrence of torsade de pointes (eg, dizziness, palpitations, syncope) may warrant further cardiac evaluation in particular, consider Holter monitoring. 

Gomes JA, Winters SL, Stewart D, Horowitz S, Milner M, Barreca P. A new noninvasive index to predict sustained ventricular tachycardia and sudden death in the first year after myocardial infarction based on signal-averaged electrocardiogram, radionuclide ejection fraction and Holter monitoring. J. Am. Coll. Cardiol. 1987 10 349-57. 

Figure 9 Pharmacodynamic relationship observed at steady state in 24 subjects for various doses of a sustained-release (once daily) verapamil formulation. The concentration measure used is the area under the S-verapamil concentration over the 24-hr dosing interval the effect measure used is the area under the PR interval curve (measured with Holter monitor) over the 24-hr dosing interval. The doses of sustained-release verapamil that resulted in each concentration-effect pair are also shown.

The single- and multiple-dose pharmacokinetics of ebastine (10 mg) have been determined in elderly and young healthy subjects using 24-hour Holter monitoring (37). There were no clinically relevant effects. 

Berisso MZ, Cavallini A, lannetti M. Sudden death during continuous Holter monitoring out of hospital after nitroglycerin consumption. Am J Cardiol 1984 54(6) 677-9. 

A 57-year-old woman had been taking a formulation containing orphenadrine 15 mg and paracetamol 450 mg bd for musculoskeletal pain. She was also taking propafenone 600 mg/day for paroxysmal atrial fibrillation. After 5 days she developed severe palpitation. Holter monitoring showed frequent brief episodes not only of atrial fibrillation but also of non-sustained ventricular tachycardia. After the orphenadrine was withdrawn the palpitation ceased. 

A 54-year-old man with hjrpertrophic cardiomyopathy, for which he took verapamil, felt unwell after a single tablet of sildenafil (10). Holter monitoring after repeat sildenafil showed an increase in ventricular extra beats and episodes of non-sustained ventricular tachycardia. On echocardiography, left ventricular dimensions were reduced and the subaortic gradient was markedly increased. 

The first of these methods was the first explored by researchers [64, 90-94], and after 30 years of effort, there is finally a continuous glucose monitoring system (CGMS), which is currently marketed by MiniMed (Silmar, CA, USA). Up to now, it has only been used by healthcare professionals [95]. The system employs an approach similar to a Holter monitor, 72-h implantation, automatic glucose measurement every 5 min, and a 2-week data-storage capability. The sensor is a tiny electrode inside a small needle that is introduced under the skin. Once inserted, only the sensor remains under the skin and a thin cable connects the sensor to a pager-sized glucose monitor. 

Figure 12.2 During Holter monitoring in a patient with ischaemic heart disease, crises often silent with ST-segment elevation or depression may be recorded.

DiMarco JP, Philbrick JT. Ambulatory electrocardiographic (Holter) monitoring. Ann Intern Med 1990 113 77-79. 

Reiter MJ, Karagounis LA, Mann De, et al. Reproducibility of drug efficacy predictions by Holter monitoring in the electrophysiologic study versus electrocardiographic monitoring (ESVEM) trial. Am J Cardiol 1997 79 315-322. 

Normal findings included electrolytes, liver and renal function tests, WBC count, ECG, computed tomography (CT) scan, EEG, and 24-h Holter monitoring. Physical exam revealed generalized weakness and a broad-based gait. He recovered fully the following day. 

Therefore, in patients post-MI with ischemic cardiomyopathy, NSVT may predict SCD and total mortality however, the incremental risk stratification in patients with LVEF <35% is unclear. The utility of obtaining routine Holter monitors for screening in this population is unclear and not currently recommended (77). NSVT may be more useful in patients post-MI with LVEF over the range of 35% to 40% however, it is difficult to separate the predictive ability of NSVT versus EP study in this population. In patients with nonischemic cardiomyopathy, NSVT has not been demonstrated to reliably predict SCD. 

Kuchar DL, Thorburn CS, Sammel NL. Prediction of serious arrhythmic events after myocardial infarction singla averaged electrocardiogram, Holter monitoring and radionuclide ventriculography. J Am Coll Cardiol 1987 9(3) 531-8. 

In addition to use in implanted devices, small batteries are the power source for hand-held and portable instruments some applications are telemetry receivers, pacer system analyzers, pacemaker programmers, and Holter monitors. 

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