Much like standard electrocardiography (ECG), the Holter monitor records electrical signals from the heart via

a series of electrodes attached to the chest. The number and position of electrodes varies by model, but most Holter monitors employ from three to eight. These electrodes are connected to a small piece of equipment that is attached to the patient's belt, and is responsible for keeping a log of the heart's electrical activity throughout the recording period. Holter monitoring was introduced 40 years ago in 1963. Breakthroughs in technology have reduced the size and weight of the recorders (making them easier for the patients to wear), reduced artifact in recording, increased memory capacity, drastically improved the diagnostic capabilities and automated much of the procedure. As a result, the procedure is being done not only by cardiologists, but by many primary care physicians as well.

Indications for Holter Monitoring • Syncope (fainting spells) • Weakness • Chest pain • Abnormal ECG • Post MI • Nausea accompanied by weakness • Dizziness

What type of Physicians perform Holters? • Family and general practitioners • Cardiologists • DOs • Internal medicine physicians

Key Terms

Arrhythmia – Refers to an abnormal or out-of-rhythm heartbeat. Some of the common ones include PVCs or premature ventricular contractions (big wide abnormal beat), tachycardia (very rapid heartbeats), bradycardia (very slow heartbeats), pause (a gap between beats), V-Tach (series of PVCs) and Couplets (two PVCs in a row).

ST Analysis – Looking at the ST segment of the ECG waveform to see if it is elevated or depressed. ST depression can signal “silent ischemia,” which can cause death if not properly treated.

ST segment – a small section on the ECG between the ‘S’ wave and the ‘T’ wave, which represents the period of time during which the lower chambers of the heart are depolarized.

MI or Myocardial Infarction – a heart attack.

QT Analysis – Looking at the QT segment of the ECG waveform to identify differences (prolongation) that may lead to sudden heart failure.

Superimposition – the ability to view on the monitor any recorded heartbeats overlaying one waveform on top of another.

Full Disclosure – the ability to reproduce every heartbeat.

CPT Codes 93230 Electrocardiograph monitoring for 24 hours by continuous original ECG waveform recording and storage without superimposition scanning utilizing a device capable of producing a full miniaturized printout; includes recording, micro-processor-based analysis with report, physician review and interpretation.
Key featurss to look for when buying a Holter ecg system: 1 - Does it have real time ecgs on the recorder or computer

screen during the preview time before recording? This is good t be sure the patient hookup is good before sending the patient out of the office. 2 - Does it have at least one channel with good quality ECGs traces? It is very important that a Holter system can give readable ECGs for most of the recording test. Some machines do well with good prep and supplies. 3 - Does it analyze the main Holter parameters well, like: VE, VE runs, Couplets, Bigem, Trigem, SVE, SVE runs? These make a good complete arrhythmia group. 4 - Does it have the ability to reanalyze the Holter again changing channels, sensitivities, definitions, etc? 5 - Does the system have the ability to produce a comprehensive summary report that can also be stored in its database? 6 - Does it have the ability to export its ECGs and reports in File formats that can be read by anything? Such as pdf files? This is very nice as they can be put into EMR programs and Even sent to colleagues for review. Specialized EMR interfaces Aren’t as useful as they limit the ability to transmit to Others the reports by email, etc. Standard file formats such as pdf solve that compatibility problem easily. 7 - Is the database unlimited? This is important so there is no limit on the system's use. 8 - Is the software networkable? This is important for sharing data, backups, etc.