Name of the Procedure:

External Electrocardiographic Recording up to 48 Hours by Continuous Rhythm Recording and Storage; Recording

Common name(s): Holter Monitoring, Ambulatory ECG Monitoring

Summary

Holter monitoring is a non-invasive procedure where a device continuously records your heart's electrical activity for up to 48 hours. This device, called a Holter monitor, is portable and allows you to go about your daily activities while it monitors your heart rhythm.

Purpose

Holter monitoring is used to identify irregular heart rhythms and other cardiac abnormalities that might not show up during a standard, shorter electrocardiogram (ECG). The goal is to detect issues such as arrhythmias, palpitations, or silent myocardial infarctions (silent heart attacks).

Indications

• Symptoms such as palpitations, dizziness, syncope (fainting), chest pain, or shortness of breath.
• Suspected arrhythmias or abnormal heart rhythms not captured during a standard ECG.
• Monitoring the effectiveness of heart medications or other treatment interventions.
• Assessing the heart's activity in patients with a history of heart disease.

Preparation

• Patients are generally advised to take a shower before the start of the procedure, as the monitoring equipment should not get wet.
• Wear comfortable, loose-fitting clothing to accommodate the monitor.
• Patients should inform their doctors about all medications they are taking.
• No other special preparation, like fasting, is usually required.

Procedure Description

1. Connection: A technician will attach electrodes (small sticky patches) to the patient's chest. These electrodes are connected to a portable recording device (Holter monitor) which can be worn around the waist or on a shoulder strap.
2. Recording: The monitor records the electrical activity of the heart continuously over 24 to 48 hours. The patient will be asked to keep a diary to note any symptoms, activities, or times of rest or stress.
3. Disconnection: After the recording period, the patient returns to have the monitor and electrodes removed. The device is then taken to be analyzed by healthcare professionals.

No anesthesia or sedation is required for this procedure.

Duration

The total duration for attaching and removing the monitor is about 30 minutes. The recording period lasts continuously over 24 to 48 hours.

Setting

The procedure is typically performed in an outpatient clinic, a cardiologist’s office, or in some cases, at home using mailed monitors.

Personnel

• The procedure is usually conducted by a trained technician or nurse.
• A cardiologist or other healthcare provider will analyze the recorded data.

Risks and Complications

• Minor skin irritation where the electrodes are placed.
• There are no significant risks or complications associated with Holter monitoring.

Benefits

• Provides continuous, long-term monitoring that can catch irregularities not seen on a standard ECG.
• Helps in diagnosing the cause of symptoms like palpitations or dizziness.
• Assists in assessing the effectiveness of current treatments or medications.

Recovery

• There is no recovery period, and patients can resume normal activities immediately after the monitor is removed.
• Follow-up appointment might be scheduled to review the results and discuss any necessary treatments.

Alternatives

• Event Monitor: Records heart activity only when the patient indicates symptoms via a button press.
• Standard ECG: A shorter test that captures heart activity at a single point in time.
• Implantable Loop Recorder: A device implanted under the skin for long-term monitoring.

Patient Experience

The patient might experience mild skin irritation due to electrodes. They should be able to carry on with most normal daily activities but should avoid getting the device wet and high-impact activities that might displace the electrodes. Pain is minimal to none, and any discomfort is usually manageable with the application of soothing creams post-procedure if irritation occurs.