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Norman Jefferis “Jeff” Holter was a pioneer in the field of ambulatory electrocardiography, and the inventor of the portable cardiac telemetry device that bears his name and is used worldwide to this day. He famously made a case for continuous ambulatory cardiac monitoring by comparing the collection of heart data with the work of a mining engineer, who “does not assay a mountain of ore by testing one rock.”
Jeff Holter’s words resonate with many physicians who have stood by the bedside of a patient with a suspected rhythm disturbance, only to have a benign-looking electrocardiogram on hand. As a single rock sample cannot reveal the riches of ore within a mountain because of sampling…
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Ambulatory monitoring (Holter monitoring and event recorders) is done to record a patient's ECG for a prolonged period of time, on an outpatient basis. The purpose of ambulatory monitoring is to look for evidence of transient cardiac problems - that is, problems that come and go, and that are not apparent when a standard ECG is performed.
After the exchange of a few emails, my doctor ordered an at-home, 30-day heart monitor. It’s a marvel of modern technology. Electrodes on my chest fed my heart’s rhythm, over wires, to a recorder on my belt, which wirelessly communicated the data to my physician. With onboard software, it continuously monitored for signs of a heart attack. As amazing as this technology is, it wasn’t amazing enough. The wires tickled my torso and puffed out my shirt.
Loop recorders are event recorders with a ‘loop memory’: they continually analyse the ECG and retain information pertaining to relevant arrhythmias that are automatically detected thanks to predefined algorithms and the registration of the ECG a few minutes before the onset of the arrhythmia.
Apple’s new watch can screen for heart problems. But doctors are increasingly worried about the dangers of testing healthy people for disease.
There are ways to prevent heart disease such as embracing a healthy lifestyle and there are diagnostic tools to monitor our hearts too, thanks to the work of two creative and persistent men, Norman "Jeff" Holter (1914-1983) and Bruce Del Mar (b. 1913-).
A Holter monitor is a continuous tape recording of a patient's EKG for 24 hours. Since it can be worn during the patient's regular daily activities, it helps the physician correlate symptoms of dizziness, palpitations (a sensation of fast or irregular heart rhythm) or black outs.
An event monitor is very similar to something called a Holter monitor. This is another portable device used to analyze the heart’s signaling. Holter monitors record continuously, usually for about 24 to 48 hours. An event monitor does not record continuously. Instead, it records when you activate it. Some event monitors will automatically start recording if an abnormal heart rhythm is detected. Event monitors can be worn for a month or longer.
Contemporary cardiac and heart rate monitoring devices capture physiological signals using optical and electrode-based sensors. However, these devices generally lack the form factor and mechanical flexibility necessary for use in ambulatory and home environments.
Rapid advances in technology to monitor atrial fibrillation (AF or Afib) are enabling clinicians to access real-time patient data more easily and effectively than ever before. The challenges of obtaining data through previous technology like Holter monitors have limited the clinician’s ability to better understand AF burden and its connection to increased stroke risk.
The explosion in smart devices—phones, watches, fitness gadgets and the like—has unleashed a wave of apps designed to manage chronic illnesses, detect behavioral diseases and manage pain. Most recently, Apple announced that apps due later this year will allow its Series 4 watches to perform electrocardiogram readings, or ECGs, and notify users of irregular heart rhythms. The problem for consumers is knowing which apps—if any—actually work.
An implantable loop monitor is, as it sounds, a “paper clip-sized” device that can be implanted just underneath the skin, left of the breastbone. This device can serve as a literal continuous ECG-recording machine, recording a patient’s heart rhythm for up to 3 years. The biggest advantage of this system is for patients who have symptoms that are not that frequent—that is, patients who may present with syncope once every several months or even yearly, in which case short-term external monitors have limited utility.
After the exchange of a few emails, my doctor ordered an at-home, 30-day heart monitor. It’s a marvel of modern technology. Electrodes on my chest fed my heart’s rhythm, over wires, to a recorder on my belt, which wirelessly communicated the data to my physician. With onboard software, it continuously monitored for signs of a heart attack.
Several formats and variations of ambulatory electrocardiography exist, including 24- and 48-hour monitoring, use of event recorders, and, more recently, use of implantable loop recorders that can last several years. The type of ambulatory electrocardiography cardiac monitoring device chosen depends on the indication for evaluation as well as on the frequency of symptoms.
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Ambulatory monitors are small, portable electrocardiograph machines that are able to record the heart’s rhythm. Each type of monitor has unique features related to length of recording time and ability to send the recordings over the phone.
The Holter monitor may be able to detect irregularities in your heart rhythm that an electrocardiogram couldn't, since an electrocardiogram usually takes only a few minutes.
Holter monitoring gives doctors a constant reading of your heart rate and rhythm over a 24-hour period (or longer).