Holter was invented in 1957, applied to the clinic in 1961, and introduced to the mainland in 1978, and has undergone the development process of the initial single-channel, dual-channel, three-channel, 12-lead Holter to the current digital 12-lead synchronous Holter. The main steps in interpreting the report are as follows:
1 Patient profile
General patient information, including clinical diagnosis and special medications, should be reviewed, the start/end time of the analysis recorded, and the total monitoring time should be at least 24 h.
2 Heart rate data
Total heart beats: Adults 24 h The total number of heart beats is more than 80,000 to 140,000 times.
24 h Total number of heart beats 140,000, considering tachycardia;
Average heart rate: Adults have an average heart rate of 60 to 87 beats per minute for 24 hours.
Slowest heart rate: The slowest heart rate in sleep can be up to 40 beats per minute, and occasionally less than 40 beats per minute, mostly due to increased vagus nerve tone.
Slowest heart rate
Fastest heart rate: Up to 180 beats per minute of activity, decreasing with age. Older adults generally do not have a heart rate of more than 160 beats per minute when exercising.
Fastest heart rate
3 supraventricular ectopic beats
Supraventricular ectopic beats include atrial and junctional.
Room morning: 24 h Room morning is often less than 100 times (or 1/1000 or 5 times/h). Frequent atrial precocities (>5 beats per minute) are independent predictors of atrial tachycardia and progression to atrial fibrillation.
Room rate: normal human room rate incidence of 10% to 20%, generally 3 to 7 wave groups, heart rate 100 to 250 beats / min, 24 h
R-R interval: with bradycardia symptoms and the R-R interval > 3 s or the R-R interval > 6 s require treatment.
4 Ventricular ectopic beats
Ventricular premature: under normal circumstances, ventricular premature beats often less than 100 beats (or 1/1000 or 5 beats/h) for 24 h, mostly monoform ventricular early, a few occasional multi-source ventricular prematures, QRS ≤ 0.14 s, no R-on-T.
Frequency chambers 24 h > 500 times in the morning (or > 5 times/min). Ventricular ablation > 10,000 times a morning, catheter ablation helps improve symptoms and left cardiac function. Ventricular premature load (ventricular premature as a percentage of recorded total beats) > 20% is a risk factor for cardiovascular mortality.
Ventricular tachycardia: when patients report the presence of ventricular tachycardia, it is necessary to determine whether it is persistent or unsustainable.
Persistent ventricular tachycardia: the duration of monomorphic ventricular tachy is > 30 s, or duration though
Non-sustained ventricular rate: refers to 3 or more consecutive ventricular rhythms, a frequency of > 100 beats/min, a duration of < 30 s, and hemodynamically stable and self-terminating. It is generally composed of 3 to 10 ventricular rhythms, and the ventricular rate is mostly 100 to 200 beats/min.
Most of the patients recorded on Holter ecglyograms are short bursts of ventricular rate, which is common in patients with ischemic heart disease. A minority is persistent ventricular tachycardia, which needs to be managed as soon as possible.
Treatment is judged to be effective if the following criteria are met: ventricular early reduction is ≥70%, paired ventricular early is reduced by ≥80%, short burst ventricular velocity is reduced by ≥90%, ventricular speed is more than 15 consecutive times, and ventricular velocity disappears more than 5 consecutive times during exercise.
5 Heart rate variability
Refers to the difference between successive sinus heart beatS R-R intervals. It mainly reflects the dynamic balance state of cardiac autonomic regulation, is a sensitive indicator of the complexity and adaptability of the entire autonomic nervous system, can be used to judge the condition of cardiovascular and other diseases, and is an important indicator for clinical prediction of sudden cardiac death and arrhythmia events.
At present, the main analysis methods are sometimes domain analysis method, frequency domain analysis method, and nonlinear analysis method. Time domain analysis is currently the most common method, the main parameters are:
SDNN (normal sinus R-R interval overall standard deviation), SDANN 5 (mean standard deviation of the normal sinus R-R interval every 5 min period in the entire record), ASDNN 5 (standard deviation of the R-R interval every 5 min segment within 24 h), RMSSD (normal neighboring sinus R-R interval difference rms); SDNNI (standard deviation of normal R-R interval).
For the normal reference value, there is no unified standard in China, SDNN < 100 ms indicates a slight decrease in heart rate variability, and it is generally believed that time domain indicators such as SDNN, SDANN, SDNNI and other time domain indicators < 50 ms indicate a significant decrease in heart rate variability, and the case fatality rate is greatly increased.
6 QT analysis
Normally, QT women
The criteria for clinical diagnosis of long QT syndrome are ≥ 470 ms for men with QTc and ≥ 480 ms for women with QTc, and patients with short QT syndrome with a QT interval of ≤ 340 ms, who are clinically prone to atrial fibrillation and sudden cardiac death.
7 ST event
You can observe the dynamic change trend chart of the ST segment, the lead that occurs, the degree of elevation and decline of the ST segment and its pattern, the duration of stectional shift, the number of arrays, etc.
For the diagnosis of ischemia, ST-segment depression should be at least 0.5 to 1.0 mV (0.5 to 1.0 mm), at least 1 min before returning to baseline, and 2 myocardial ischemic events ≥ 5 min apart.
The total load of ST segment descent (TIB, ST segment descent × duration) can be calculated, TIB
8 Pacing analysis
Pacemaker function can be assessed, transient and intermittent periods of pacemaker dysfunction can be found, pacemaker dysfunction, pacing and the proportion of its own heart beat, various arrhythmias and their severity can be quantitatively diagnosed.
Combined with the patient's medical history, the above figure suggests a single-chamber pacing, no pacing output, no perception, no seizure, and normal pacing function.
Curated: ly
This article was first published on Lilac Garden's professional platform: Cardiovascular Time