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In medicine, a Holter monitor (often simply Holter) is a type of ambulatory electrocardiography device, a portable device for cardiac monitoring (the monitoring of the electrical activity of the cardiovascular system) worn for at least 24 hours.
The Holter's most common use is for monitoring ECG heart activity (electrocardiography or ECG). Its extended recording period is sometimes useful for observing occasional cardiac which would be difficult to identify in a shorter period. For patients having more transient symptoms, a cardiac event monitor which can be worn for a month or more can be used.
When used to study the heart, much like standard electrocardiography, the Holter monitor records electrical signals from the heart via a series of attached to the chest. Electrodes are placed over bones to minimize artifacts from muscular activity. The number and position of electrodes varies by model, but most Holter monitors employ between three and eight. These electrodes are connected to a small piece of equipment that is attached to the patient's belt or hung around the neck, keeping a log of the heart's electrical activity throughout the recording period. A 12-lead Holter system is used when precise ECG information is required to analyse the exact origin of the abnormal signals.Herzschrittmacherther Elektrophysiol. 2013 Jun;24(2):92-96. . Epub 2013 Jun 19. 12-lead Holter electrocardiography. Review of the literature and clinical application update. Su L1, Borov S, Zrenner B.
Most Holter Monitors monitor the ECG via two or three channels. Depending on manufacturer, different lead systems and numbers of leads are used; the number of leads may be minimised for patient comfort. Two or three channel recording has been used for a long time in the Holter monitoring history; 12-channel Holters were introduced later, using either the standard 12-lead electrocardiograph or the modified (Mason-Likar) exercise lead system.
These Holter monitors can occasionally provide information similar to that of an ECG cardiac stress test examination. They are also suitable when analyzing patients after myocardial infarction. Recordings from these 12-lead monitors are of a significantly lower resolution than those from a standard 12-lead ECG, and in some cases have been shown to provide misleading ST segment representation, even though some devices allow setting the sampling frequency up to 1000 Hz for special-purpose examinations such as detection of "Late potentials".
Another innovation is the inclusion of a triaxial movement sensor, which records the patient's physical activity and, on examination and software processing, extracts three movement statuses: sleeping, standing, or walking. Some modern devices can record spoken patient diary entries that can be listened to.
We now also have a wireless Holter monitor available, with 1 to 3 channels, which allows heart rhythm continuous monitoring from 24 hours to 14 days, increasing the diagnostic yield.
The automatic analysis commonly provides the physician with information about heart beat morphology, beat interval measurement, heart rate variability, rhythm overview and patient diary (moments when the patient pressed the patient button). Advanced systems also perform spectral analysis, ischemic burden evaluation, graph of patient's activity or PQ segment analysis. Also possible is the ability to monitor and analyse pacemaker impulse detection, useful for checking pacemaker function.
Some platforms already use Artificial Intelligence, which helps with cleaning artifacts, classifying heartbeats and can even generate a pre-report, which must be validated by a specialist doctor.
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