Holter dmo

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  • 1. Holter Recording
  • 2.  
  • 3. Indications for AECG
    • Patients with unexplained syncope, near syncope or episodic dizziness in whom the cause is not obvious
    • Patients with unexplained recurrent palpitation
    • To assess antiarrhythmic drug response
    • Pacemaker and ICD function
    • Patients with suspected variant angina
    • Evaluation of possible or documented long QT
    • syndromes
  • 4. AECG equipment
    • In 1957, Dr. Norman Holter introduces portable devices to record the ECG
    • Current AECG equipment provides the detection and analysis of arrhythmias , ST-segment deviation, R-R intervals , QRS-T morphology
  • 5. Two categories of AECG recorders
    • Continuous recorders
    • Intermittent recorders
  • 6. AECG equipment…
    • Continuous recorders
    • Used for 24 to 48 hours , which investigate symptoms or ECG events that are likely to occur within that time frame
    • Intermittent recorders
    • Used for long periods of time (weeks to months) to provide briefer, intermittent recordings to investigate events that occur infrequently
  • 7. Intermittent recorders…
    • External insertable loop recorder
    • Recording from external ILR
  • 8. Intermittent recorders
    • Loop recorder
    • It should be worn continuously
    • Particularly useful if symptoms are quite brief or if symptoms include only very brief incapacitation of the patient
    • Family members can activate the recorder if the patient actually loses consciousness
    • Newer loop recorders can be implanted under the skin for long-term recordings
  • 9. Intermittent recorders…
    • Event recorder
    • It should be attached by the patient and activated after the onset of symptoms
    • It is not useful for arrhythmias that cause serious symptoms such as loss of consciousness or near loss of consciousness because these devices take time to find, apply, and activate
    • They are more useful for infrequent, less serious but sustained symptoms that are not incapacitating
  • 10. Continuous recorders
    • Conventional AECG recorders typically are small, lightweight devices
    • They contain a quartz digital clock and a separate recording track to keep time
    • A patient-activated event marker is conveniently placed on the device for the patient to indicate the presence of symptoms or to note an event
  • 11. Continuous recorders...
    • Limitations
    • Expense
    • Limited storage capacity of digital data
  • 12. Continuous recorders...
    • Storage methodologies
    • 1.Flash memory card
    • 2.Portable hard drive
  • 13. Continuous recorders...
    • Flash cards
    • Very small, compact storage devices, size of a credit card
    • Storage capacity --- 20 to 40MB
    • Removed from the recording device once the recording is completed
    • Inserted into a separate device where the data can be played back and analyzed
  • 14. Continuous recorders...
    • Portable hard drive
    • Utilize the same technology used in laptop computers
    • Storage capacity --- >100MB
    • It cannot be removed from the recorder
    • Data to be downloaded to another storage device or electronically transferred
  • 15. Methods of electrode preparation
    • The skin over the electrode area should be
    • Shaved
    • Gently abraded
    • Cleansed with an alcohol swab
  • 16. Methods of analysis
    • Arrhythmia Analysis
    • Each beat is classified as normal,VPC,APC,paced, others or unknown
    • Summary data describing the frequency of atrial and ventricular arrhythmias are displayed typically in both tabular and graphical formats
  • 17. Methods of analysis…
    • Conditions not suitable for interpretation
    • LVH
    • Preexcitation
    • LBBB
    • Marked baseline ST-segment distortion
  • 19. Determination of the relation between patient’s transient symptoms to cardiac arrhythmias
    • Commonly caused by transient arrhythmias
    • 1.Syncope
    • 2.Near syncope
    • 3.Dizziness
    • 4. Palpitation
    • Less commonly caused by transient arrhythmias
    • 1.Shortness of breath
    • 2.Chest discomfort
    • 3.Weakness
    • 4.Diaphoresis
    • 5.Transient ischemic attack
    • 6.Vertigo
  • 20. After Myocardial Infarction
    • The 1-year risk of developing a malignant arrhythmia in an MI survivor after hospital discharge is 5% or less
    • The goal in risk-stratifying ---
    • To identify at high risk patients
    • Reduce arrhythmic events with an intervention
  • 21. After Myocardial Infarction…
    • The goal in risk-stratifying …
    • PVCs associated with a higher mortality
    • Frequent PVCs (10 per hour)
    • High-grade ventricular ectopy (repetitive PVCs , multi-form PVCs,VT)
  • 22. After Myocardial Infarction…
    • AECG is not needed in
    • Asymptomatic post-MI patients EF > 40% ---malignant arrhythmias are rare
  • 23. Thank you