Holter Recording
Case history :
11 years old boy had occasional chest pain for last 4-5 months. It is of sudden onset and often associated with feeling of fast heart beat. There is no history of breathlessness or giddiness during the episode . No history of syncope. His initial ECG shows following pattern.
What should be next step?
ECG shows ventricular bigeminy – every alternate beat is premature ventricular ectopic beat with monomorphic character. It will be worth doing Holter test in this case.
HOLTER RECORDING
The Holter monitoring , invented by Dr Norman Holter, is a device that records the heart rhythm continuously for 24 to 72 hours. This recorder is useful when frequency of arrhythmia is high but not documented during clinic or OPD visit. It may not be useful when symptoms are infrequent(eg. once in 3-4 months). A wide variety of information may be obtained from recording over 2-3 days like frequency, duration and types of arrhythmias. As the device is synchronized with time , precipitating or terminating event of an arrhythmia may be identified.
Common symptoms associated with arrhythmia are palpitations , syncope ,chest pain or breathlessness. Many times significant arrhythmias are not associated with symptoms and may worsen during sleep. Brady-arrhythmia ( HR < 50/min ) or tachyarrhythmia ( supraventricular tachycardia or ventricular tachycardia) are potentially life threatening. . Holter test may help to identify these rhythm problems.
Common indications for Holter test :
- 1. To identify whether symptoms such as chest pain ,palpitations and syncope are caused by cardiac arrhythmia.
- 2. To screen high risk cardiac patients such as hypertrophic cardiomyopathy or those who have had cardiac surgeries for complex cyanotic CHDs.
- 3. To screen for malignant arrhythmia in cases having frequent ectopic ( premature atrial or ventricular beats )on ECG.
- 4. To evaluate the adequacy of medical therapy for an arrhythmia.
