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Appropiate Holter Monitoring

Faris Basalamah,MD
InaHRS 2017

Numbers of Channels
Each Holter model has its specific advantages with respect to number
of ECG channels :

• 3 channels - Suitable for the detection of common heart rate and conduction
defects. It is however not possible to determine the place of arrhythmia

• 7 channels – The QRS shape corresponds to the one obtained from Resting
ECG. Hence it has the same possibilities as 3 channels, but even the place
of arrhythmia origin can be determined (mainly due to lead III).

• 12 channels – The most comprehensive system, offers the same
possibilities as 7 channels and even a detailed ST segment analysis, which
can be used e.g. to diagnose silent ischemia. This system can also be used
to substitute the Stress-test examination.

7 or 12 ECG channels. 3 channels 5 leads. 7 channels 10 leads. HOLTER RECORDER • The BTL-08 Holter is produced in three models allowing to record 3. 5 leads. 12 channels BTL CardioPoint-Holter .

INTERPRETATION • Premature Ventricle/atrial Contraction detection – Frequency. Therapy efficacy. Source of cryptogenic stroke – Relief tool • Ischemic detection • Pacemaker/ICD evaluation • Evaluation of SCD predictor – HRV – T wave alternans – Late potential (SAECG) . Origin • Tachyarrhythmia (NSVT. SVT) detection • Brady arrhythmia detection • Symptom related arrhythmia? • Atrial fibrillation detection – Diagnose.

It is possible to set the limits for Bradycardia.. BTL CardioPoint-Holter . ST. Prematurity levels. QT(c). The PQ trend shows the PQ interval development in time. the physician can also change the alarm limits for PQ. Analysis Criteria The software allows one to change the analysis criteria. Tachycardia. Pacemaker settings etc. Pauses etc.

editing and printing .Report review.

Various screens provide a different look at the ECG signal and various diagnostic tools. This analysis can be later modified in the software. BTL CardioPoint-Holter . gender. The analysis is performed automatically and respects patient’s demographics (age. pacemaker presence. The Holter analysis software • The BTL CardioPoint-Holter is a software module for ECG Holter record review and analysis. …). The software is primarily operated by means of Navigation buttons (all of them have their equivalent on the keyboard).

The user does not need to adapt to this software. the software adapts to its user. graph BTL CardioPoint-Holter of patient’s activity and Full View ECG . Fully customizable user-interface The user-interface can be fully customized to satisfy the user and his needs. Example: Default Template screen Modified Template screen showing the HR trend.

they do not have their representative beat. The homogenous templates are formed by beats with the same shape and their representative beat is displayed in the template window. Homogenous templates • The software distinguishes the homogenous and non-homogenous templates. • With this division. The non-homogenous templates are formed by beats that may differ significantly. Homogenous template (with its representative beat) Non-homogenous template (message “Mixed shapes” informs that the template can not be represented by any beat) BTL CardioPoint-Holter . the physician knows which templates should be verified precisly (non-homogenous) and which do not need the verification (homogenous).

Move the slider to review all the beats within a template. especially when there are too many beats within one template and reviewing them in the signal strip would be too time consuming. The tiles view can be also used when reviewing the events (e. Tiles view • The Tiles view is an excellent tool for fast review of heart beat morphology. each cell displays one beat from the selected template. the user can quickly review large number of beats at once. …) In the Tiles View. Max HR.g. With this view. Max RR. BTL CardioPoint-Holter 10 .

CardioPoint Holter Kemudahan dan kecepat menganalisa rekaman Holter Tiles View Homogenous Templates Cardiology Dept of BTL 11 Indonesia .

CardioPoint Holter Kemudahan dan kecepat menganalisa rekaman Holter Relief Summary Screen Waterfall Cardiology Dept of BTL 12 Indonesia .

CardioPoint Holter Kemudahan dan kecepat menganalisa rekaman Holter Ventricular extrasystoles Pauses Low HRV Atrial Fibrilation Pointcare Cardiology Dept of BTL 13 Indonesia .

CardioPoint Holter Alat diagnostik yang canggih untuk menunjang Analisa Holter Grafik Aktivitas Pasien Cardiology Dept of BTL 14 Indonesia .

CardioPoint Holter Alat diagnostik yang canggih untuk menunjang Analisa Holter Analysis Criteria Cardiology Dept of BTL 15 Indonesia .

Cardiology Dept of BTL 16 Indonesia . CardioPoint Holter Alat diagnostik yang canggih untuk menunjang Analisa Holter Each pacemaker spike is clearly marked in the ECG strip Analysis Pacemaker yang canggih The dispersion graphs show how are the particular events distributred in time.

Practically the whole record can be reviewed and analyzed using this simple screen. BTL CardioPoint-Holter 17 . Use the Navigation buttons to browse the events and correct the invalid values if necessary. Summary screen • The Summary screen gives a clear overview of all important cardiac events that were detected in the signal. Summary The Summary table screen contains the list of cardiac events and their corresponding value (count).

may enhance sensitivity to detect ischemia. in which the positive electrode is placed on the left posterior axillary line.80:1–5. Mascellanti M. Placentino M.* • Addition of CM5 + CM3 increasing sentivity to 91% and CM5+ inferior lead 94%. .** *Lanza GA. The inverse Nehb J lead increases the sensitivity of Holter electrocardiographic monitoring for detecting myocardial ischemia. Am J Cardiol 1997. Skarvan K. et al. **Seeberger MD.74:1216 –9. Usefulness of a third Holter lead for detection of myocardial ischemia. et al. Ischemic Detection • CM5 (chest modified V5) is the most sensitif lead that has sensitivity 89% in prediction of ischemic.* • CM5+CM3 + Inferior lead has 96% sensitivity to predict ischemic.* • Use of an inverse Nehb J lead. Am J Cardiol 1994. Moerlen J.

it can be used for checking the correct functionality of the pacemaker. Thus. Furthermore. etc. Advanced Pacemaker Analysis The software offers a clear overview of all paced heartbeats. Each pacemaker spike is clearly marked in the ECG strip The dispersion graphs show how are the particular events distributred in time.). fail to sense. it provides the user with the advanced analysis (such as fail to capture. BTL CardioPoint-Holter 19 .

Reporting .

Panduan pelaporan dari Guidelines EKGA PERKI-InaHRS 2017 • Irama dasar • Kompetensi kronotropik • Konduksi AV • Tachyarrhytmia • Bradyarrhytmia • Segmen ST • Korelasi dengan keluhan • Fitur khusus .

thanks .