Daily ECG monitoring (Holter)

What is Holter monitoring?

Holter monitoring (or 24-hour ECG monitoring) is a method of continuous electrocardiogram recording for 24-48 hours (sometimes longer) using a portable device. Named after American biophysicist Norman Holter.

Indications for the procedure

Main recommendations:

• Standard: 24 hours
• If needed: 48-72 hours or even a week

Behavior rules during monitoring

Allowed:

• Normal daily activity
• Work (if not related to heavy physical exertion)
• Food without restrictions
• Driving (carefully)
• Sleep in normal position

Prohibited:

• Washing, shower, bath, sauna
• Swimming
• Intense physical exercise
• MRI and other procedures with electromagnetic radiation
• Chest X-ray

Caution:

• Mobile phones – keep more than 30 cm from the recorder
• Microwave ovens – do not stand close during operation
• Electric razors, hair dryers – use quickly

Keeping a diary

Mandatory to record:

• Time and nature of complaints (chest pain, palpitations, dizziness)
• Physical activity (climbing stairs, fast walking)
• Medication intake with exact time
• Emotional state (stress, anxiety)
• Sleep (time of falling asleep and waking up)

Example entry:

“08:30 – climbing stairs to 3rd floor, palpitations” “14:15 – chest pain while watching news, duration 5 minutes”

Possible complications and discomfort

Most common:

• Skin irritation from electrodes (especially in people with sensitive skin)
• Discomfort from wires during sleep
• Psychological discomfort from restrictions

Rare:

• Allergic reaction to electrode adhesive base
• Skin infection (with violation of hygiene rules)

Results interpretation

What the doctor evaluates:

• Average heart rate over 24 hours
• Minimum and maximum HR
• Circadian rhythms (day/night variations)
• Arrhythmias (their type, frequency, duration)
• Ischemic episodes (ST-segment depression)
• Heart rate variability

Normal values:

• Average HR: 60-100 bpm during day, 40-60 bpm at night
• Isolated extrasystoles: up to 100 ventricular and up to 1000 atrial per day
• Pauses: up to 2.5 seconds at night

Method advantages

Main benefits:

• Non-invasive – completely painless
• Informative – detects “hidden” rhythm disturbances
• Correlation possibility of symptoms with ECG changes
• Treatment effectiveness evaluation
• Prognostic value in ischemic heart disease

Disadvantages and limitations

Drawbacks:

• Discomfort from wearing the device
• Activity restrictions for 24 hours
• Possible artifacts from movement
• Doesn’t always “catch” rare arrhythmias
• Subjectivity of diary keeping

Alternative methods

When Holter is not suitable:

• Implantable loop recorders – for long-term monitoring
• Event recorders – activated by patient during symptoms
• Telemetric monitoring – in hospital
• Mobile apps with ECG function (Apple Watch, AliveCor)

Special considerations for different patient groups

Children:

• Require special approach to electrode fixation
• Parents should help with diary keeping
• Often use bright “pediatric” recorders

Elderly people:

• May need help with diary keeping
• More often have skin reactions to electrodes
• Need detailed explanation of rules

Pregnant women:

• Completely safe for mother and fetus
• Can detect pregnancy-related arrhythmias
• Helps assess the impact of hormonal changes on the heart

Cost and accessibility

In Ukraine:

• Public facilities: often free with referral
• Private clinics: 800-2000 UAH
• Waiting time: from several days to a month

Insurance coverage:

• Usually covered by medical insurance when indicated

Practical tips

Before the study:

• Choose a day with usual activity
• Prepare comfortable clothing
• Inform family about restrictions

During wearing:

• Do not touch electrodes unnecessarily
• Keep diary carefully
• If an electrode comes off – contact the clinic immediately

After removal:

• Carefully remove adhesive residue (with baby oil)
• If skin irritation occurs – use soothing cream

Current trends

New technologies:

• Wireless systems – no wires between electrodes and recorder
• Artificial intelligence for automatic analysis
• Smartwatches with ECG function
• Patch monitors – thin as a patch

Information source: Recommendations of the European Society of Cardiology (ESC), American Heart Association (AHA) and domestic protocols of the Ministry of Health of Ukraine.

Remember: this review is for informational purposes. The final decision about the need for the study and interpretation of results should be made by a cardiologist!