ECG Holter: Guide to Electrocardiographic Interpretation - Adamec Jan
Год выпуска: 2008Автор: Adamec Jan, Adamec Richard
Жанр: Кардиология
Формат: PDF
Качество: OCR
Описание: Long-term ECG recording has been known for some time but has recently been further developed owing to miniaturisation, digitalisation, and an increase in memory.
First of all, the newer techniques have improved the Holter method, which was first invented in the 1960s. Moreover, devices are currently being developed which can record ambulatory ECG for several days, and subcutaneous implanted loop recording devices can monitor the heart rhythm for more than a year. However, these event recorders only detect arrhythmic events that can be predefined in a very inpidualised manner.
Even with this progress in computerisation, indeed probably because of it, correct electrocardiographic interpretation remains the cornerstone for the accurate diagnoses that can be obtained through these very sophisticated methods.
We thought it useful to combine the quarter of a century of experience of one of us with the approach of a young cardiologist trained in the new time and era of modern cardiology, very focused on technology. Thereby we can offer the reader of this interpretation manual not only an explanation of the advantages of the method but also an understanding of its peculiarities and limits. As put explicitly in the title, we do not want to enter into the details of the indications and therapeutic proposals, but we do want to focus on the pure electrocardiographic diagnosis. There is already much literature on arrhythmias discovered via Holter recordings, but to use it properly one first has to be sure of the electrocardiographic diagnosis.
The long-term electrocardiographic recording, also known as ambulatory ECG recording was invented by Norman J. Holter at the beginning of the 1960s, and his name was given to this new diagnostic tool. Now under the name ECG Holter we imply a recording of all cardiac complexes for at least 24 hr. Its usefulness in the diagnosis of different arrhythmias and later in the diagnosis of myocardial ischemia, especially silent myocardial ischemia, has engendered a favourable technical evolution. It has led, on the one hand, to miniaturisation of the recording device itself and, on the other hand, to the provision of three leads, so that recording can take place without limitation during daily activities and night time sleep.
At the same time, the reading devices started to become semiautomatic and sometimes even fully automatic to accelerate the reading and offer different calculations of the events.
In principle, there are two types of reading devices: The first requires a learning process during the first reading in order to distinguish between the wide ventricular complexes and the narrow supraventricular complexes for premature beats and tachycardia, as well as to eliminate artefacts. The device then remembers the criteria introduced during the first "learning" reading and does not stop on a complex which has already been analysed, so that the second reading is done in an automatically.
The second type takes an automatic reading based on ventricular complexes considered to be normal according to templates and registers all the others as abnormal. Nevertheless, the human reader may—or even better said must—verify the complexes judged by the machine to be normal in order to identify any that may actually be pathological and especially to eliminate artefacts. This second device seems to work faster at first, but once one takes the time to verify the complexes and the arrhythmias this is usually no longer the case.
The speed of the lecture depends firstly on the presence or absence of the different arrhythmias and even more on the quality of the tracing and its purity. An artefact is much more easily recognised by the experienced human eye than by an automatic reading device.
All reading devices ignore atrial activity and do not recognise the P wave. The presence and the relation of the P waves with the ventricular complexes remains the key for correct diagnosis of most arrhythmias, and this escapes the automatic reading device. The performance of the automatic reading depends on this. It is optimal for the premature ventricular beats, the ventricular tachycardia, and even supraventricular tachycardia, but cannot avoid the pitfall of an intraventricular aberration. All the other arrhythmias escape detection in an automatic reading.
A new generation of devices is now at our disposal. These are digitalised recorders with memory: there is no tape so no tape-related artefacts, such as an incorrect movement of the tape, are present. These recorders need very extensive memory storage because too much compression of the signal's graphic reproduction of the cardiac activity can alter the precision of the cardiac complex.
Contents
«ECG Holter: Guide to Electrocardiographic Interpretation»
Technical Aspects
- Recording
- Recorders
- Reading Systems
- Manual Reading
- Semiautomatic Reading
- Automatic Reading
- Miniature Tracing
- Real-Time Interpretation
- Artefacts
- Artefacts Associated with the Recording
- Artefacts Associated with to the Recording Device
- Artefacts Associated with Interpretation
Electrocardiographic Interpretation
- Peculiarities and Limits of ECG Holter Interpretations
- Basic Cardiac Rhythms
- Sinus Rhythm
- Atrial Fibrillation
- Atrial Flutter
- Atrial Tachycardia
- Ventricular Tachycardia
- Atrial Silence
- Supraventricular Hyperexcitability
- Supraventricular Premature Beats
- Supraventricular Tachycardia
- Atrial Fibrillation
- Atrial Flutter
- Ventricular Hyperexcitability
- Ventricular Premature Beats
- Ventricular Tachycardia
- Differential Diagnosis of a Wide QRS Tachycardia
- Accelerated Idioventricular Rhythm (AIVR)
- Pauses and Bradycardia
- Generalities
- Sinus Bradycardia
- False Sinus Bradycardia
- Atrioventricular Bradycardia
- Sinus Dysfunction
- Post-Premature Atrial Blocked Beat
- Bradycardia during Atrial Fibrillation
- Bradycardia owing to Artefacts
- Pauses Provoked by Artefacts
- Cardiac Conduction Troubles
- Sinoatrial Level and Sinoatrial Blocks
- Atrioventricular Blocks
- Bundle Branch Blocks
- Preexcitation
- ST Segment Analysis
- Generalities
- Myocardial Ischemia
- ECG Holter and Pacemakers
- Generalities
- Interpretation of Pacemaker Function
- Pacemaker Tracings and Spontaneous Rhythms
- Summary of the Different Stimulation Modes on the ECG Holter
- Example of a Holter ECG Report Pacemaker Patient
Presenting ECG Holter Data
- Frequency Trend
- Hourly Expressions
- Histograms
- Electrocardiographic Transcription
Clinical Applications
Other ECG Recording Systems
ECG Holter and Implanted Cardioverter Defibrillators
ECG Report Example
Conclusion
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