Nocturnal pauses in Holter monitoring : How significant is it ?
Holter monitoring is the Initial test for all those with documented syncope (or Pre syncope ) with suspected cardiac arrhythmia .It is a 24 hour ambulatory ECG monitoring , expected to pick up any electrical abnormality and its correlation with the resultant symptom if any. Though the test looks attractive , the diagnostic yield is far less. (About 10%) .The reason being the episodes can be rare to be missed by 24hr sample time. We have extended Holter (48hr) , Event monitors , Loop recorders and implantable devices that can record ECG for extended periods.(18 Months ,Reveal Plus Medtronic) that improve the yield up to 45%.
One common issue that often confuse us while reporting Holter is, the pauses that occur during day / night .
What is the significance of these pauses * ? Nocturnal vs Daytime
Pauses are obviously significant when the patient is awake . It is generally accepted pauses more than 3 seconds during day time (ie Heart rate of < 20/mt ) is significant . This is logical , as pauses more than that, is expected to cause syncope ( or atleast pre-syncope ).The problem comes when you document pauses more than 3 seconds without any symptoms . Then this difficult question comes up ,At what degree of pause syncope occurs ? How is that some persons mange even prolonged pauses with just giddiness.(Good overall vascular integrity and tone ! )
We know such pauses are especially common during sleep. How does the brain react when pauses o...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
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