Holter dmo

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Holter dmo

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

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