Appropiate Holter Monitoring

Report
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
origin.

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.
 HOLTER RECORDER

The BTL-08 Holter is produced in three models allowing

to record 3, 7 or 12 ECG channels.

5 leads, 3 channels 5 leads, 7 channels 10 leads, 12 channels

BTL CardioPoint-Holter
 INTERPRETATION
Premature Ventricle/atrial Contraction detection
Frequency, Origin
Tachyarrhythmia (NSVT, SVT) detection
Brady arrhythmia detection
Symptom related arrhythmia?
Atrial fibrillation detection
Diagnose, Therapy efficacy, Source of cryptogenic stroke
Relief tool
Ischemic detection
Pacemaker/ICD evaluation
Evaluation of SCD predictor
HRV
T wave alternans
Late potential (SAECG)
 Analysis Criteria
The software allows one to change the analysis criteria. It is possible to
set the limits for Bradycardia, Tachycardia, Pauses etc., the physician
can also change the alarm limits for PQ, ST, QT(c), Prematurity levels,
Pacemaker settings etc.

The PQ trend shows the PQ

interval development in time.

BTL CardioPoint-Holter
Report review, editing and printing
 The Holter analysis software

The BTL CardioPoint-Holter is a software module for ECG Holter record

review and analysis. The analysis is performed automatically and respects
patients demographics (age, gender, pacemaker presence, ). This
analysis can be later modified in the software.

Various screens
provide a different
look at the ECG
signal and various
diagnostic tools.

The software is
primarily operated
by means of
Navigation buttons
(all of them have
their equivalent on
the keyboard).

BTL CardioPoint-Holter
 Fully customizable user-interface

The user-interface can be fully customized to satisfy the user and his needs.
The user does not need to adapt to this software, the software adapts to its
user.

Example:

Default Template screen Modified Template screen showing the HR trend, graph
BTL CardioPoint-Holter of patients activity and Full View ECG
 Homogenous templates

The software distinguishes the homogenous and non-homogenous

templates. The homogenous templates are formed by beats with the same
shape and their representative beat is displayed in the template window. The
non-homogenous templates are formed by beats that may differ significantly,
they do not have their representative beat.
With this division, the physician knows which templates should be verified
precisly (non-homogenous) and which do not need the verification
(homogenous).

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
 Tiles view

The Tiles view is an excellent tool for fast review of heart beat morphology,
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.g. Max RR, Max HR, )

In the Tiles View, each cell displays one

beat from the selected template. With
this view, the user can quickly review
large number of beats at once.
Move the slider to review all the beats
within a template.

BTL CardioPoint-Holter 10
 CardioPoint Holter

Kemudahan dan kecepat menganalisa rekaman Holter

Tiles View

Homogenous Templates

Cardiology Dept of BTL

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 CardioPoint Holter

Kemudahan dan kecepat menganalisa rekaman Holter

Relief

Summary Screen
Waterfall

Cardiology Dept of BTL

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Indonesia
 CardioPoint Holter

Kemudahan dan kecepat menganalisa rekaman Holter

Ventricular extrasystoles Pauses Low HRV Atrial Fibrilation

Pointcare

Cardiology Dept of BTL

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 CardioPoint Holter

Alat diagnostik yang canggih untuk menunjang Analisa Holter

Grafik Aktivitas Pasien

Cardiology Dept of BTL

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 CardioPoint Holter

Alat diagnostik yang canggih untuk menunjang Analisa Holter

Analysis Criteria

Cardiology Dept of BTL

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 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.

Cardiology Dept of BTL

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 Summary screen

The Summary screen gives a clear overview of all important cardiac

events that were detected in the signal. Practically the whole record can be
reviewed and analyzed using this simple screen.

Summary The Summary table

screen contains the list of
cardiac events and
their corresponding
value (count).

Use the Navigation

buttons to browse the
events and correct the
invalid values if
necessary.

BTL CardioPoint-Holter 17
 Ischemic Detection
CM5 (chest modified V5) is the most sensitif lead that
has sensitivity 89% in prediction of ischemic.*
Addition of CM5 + CM3 increasing sentivity to 91% and
CM5+ inferior lead 94%.*
CM5+CM3 + Inferior lead has 96% sensitivity to predict
ischemic.*

Use of an inverse Nehb J lead, in which the positive

electrode is placed on the left posterior axillary line,
may enhance sensitivity to detect ischemia.**

*Lanza GA, Mascellanti M, Placentino M, et al. Usefulness of a third Holter lead for detection of myocardial
ischemia. Am J Cardiol 1994;74:1216 9.
**Seeberger MD, Moerlen J, Skarvan K, et al. The inverse Nehb J lead increases the sensitivity of Holter
electrocardiographic monitoring for detecting myocardial ischemia. Am J Cardiol 1997;80:15.
 Advanced Pacemaker Analysis
The software offers a clear overview of all paced heartbeats.
Furthermore, it provides the user with the advanced analysis (such as
fail to capture, fail to sense, etc.). Thus, it can be used for checking the
correct functionality of the pacemaker.

Each pacemaker spike is clearly

marked in the ECG strip

The dispersion graphs show how

are the particular events
distributred in time.

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