Your cardiologist thinks you have an arrhythmia, but fails to confirm it by electrocardiogram ? You will probably have to wear a cardiac Holter for a few days or even a few weeks. This small, portable device will record the electrical activity of your heart to establish the nature of your disorder. Insights from Dr. Claude Kouakam, cardiologist, specialist in the management of heart rhythm disorders and head of the Syncope unit and the Non-Invasive Rhythmological Technical Platform at the Heart-Lung Institute of the CHU Lille.
Definition: what is a Holter in cardiology?
“A cardiac Holter allowsrecord rhythm and heart rate of a patient over an extended period ranging from 24 hours to several months, or even several years depending on the type of Holter,” says Dr. Kouakam. This device allows a completely silent and painless examination. It takes its name from its inventor, Dr. Norman Holter, an American biophysicist from the middle of the 20th century.
He understands a recorder box no bigger than a smartphone, which does not impede daily movements. Said case can be placed in a pocket, slung over the shoulder or attached to clothing. It may have a button to press in case of symptoms and is connected by relatively fine wires to several electrodes glued to the patient’s thorax (three to six electrodes depending on the model) .
All the data recorded by the Holter are thus stored in order to be analyzed by the cardiologist who can focus on certain events in particular.
Holter ECG or Holter blood pressure, what is the difference?
Blood pressure Holters do not have the same aim as ECG Holters (cardiac Holters). They allow torecord blood pressure (MAPA) to highlight a possible arterial hypertension. ECG Holters, on the other hand, record the electrical activity of the heart continuously, as indicated above.
There are implantable cardiac Holters under the skin
Most Holters have a portable case. They can be used for several days or several weeks or even several months. “But for more comfort and / or if the situation requires a recording of several months, one can opt for a subcutaneous cardiac Holter“, underlines Dr. Kouakam. And to specify: “this device is implanted under the skin at the level of the chest (to the left of the sternum) during an outpatient operation under local anesthesia”. Another significant point: it can monitor heartbeats for almost three years.
What is a Cardiac Holter used for?
“Classical electrocardiograms (ECG) measure the electrical activity of the heart for only a few minutes. This is often too little to record the events that cause disabling symptoms“, notes the cardiologist. In other words, the electrocardiogram shows no abnormality while the patients do experience symptoms.
Cardiac Holters therefore have the advantage of capturing the electrical activity of the heart over the long term, and above all as part of everyday life patients. The recording can be continuous for 24 h, 48 h, 72 h, or even several weeks, even several months. Its analysis allows the cardiologist to establish a correlation between the heart rate and any symptoms that occurred during the recording. Any recorded irregularities make it possible to:
- do a heart check in case of loss of consciousness and/or recurrent chest pain;
- detect heart rhythm disturbances (bradycardie, tachycardie, extrasystoles, etc) ;
- control the evolution of a cardiac pathology to adapt the treatment;
- check the effectiveness of a pacemaker or antiarrhythmic treatment.
Please note: these devices are suitable for both adults and children. Depending on the results, other examinations may be proposed by the medical teams to identify the origin of the abnormalities highlighted or to treat them.
New tools at the service of patients
“Conventional Holters are currently supplemented by numerous technological tools such as smartphones, watches and connected clothing that allow continuous heart rate recording. These tools are not considered medical devices (unlike Holters), but they are approved by theFood and Drug Administration (FDA) and the European Society of Cardiology“, emphasizes Dr. Kouakam.
To find out more, discover This article written by Dr Kouakam in March 2018.
How is a cardiac Holter performed (how to dress? do you have to be fasting?)?
Preparing for the placement of a Holter
Cardiac Holter is installed in about fifteen minutes, as part of a cardiology consultation (in office or in hospital). The pose does not cause any pain and does not require local anesthesia. The point on the precautions to take before the appointment:
- Eat and drink at your convenience, it is not no need to fast at the time of laying.
- take a showerbefore the appointment, because the device is not waterproff, baths, showers and other sessions in the pool are therefore prohibited for the duration of the registration.
- If you have a lot of hair on your chest, take care to shave. “The presence of too many hairs can affect the quality of the recording and limit the adherence of the electrodes”, specifies Dr Kouakam.
- D-day, choose loose clothing (for more comfort) and low necklines (to be able to conceal the electrodes). Ladies, prefer brassieres to wire-framed bras.
D-Day: everything you need to know
As indicated above, the placement of a Holter only takes about fifteen minutes. The doctor or nurse begins by disinfect the skin before attaching the electrodes to the chest. He then connects the Holter case while taking stock of the precautions for use. Finally, he installs the Holter so that it bothers you as little as possible in your daily life (in a pocket, attached to a belt, over the shoulder, etc.). Then comes the time to talk about the logbook: throughout the recording, you will have to note the symptoms felt (shortness of breath, chest pain, etc.), clearly specifying the time and the activity that you practiced when they appeared. Once the installation is complete, you can resume your daily activities without delay.
How to live with a cardiac Holter?
Rest assured right away, wearing a Holter does not present any particular risk, the device does not send any electrical impulses. On the other hand, he can be stressful on a daily basisnot to mention that if left in place too long, it may cause skin irritations.
Certain factors can also alter the quality of the recording. This is why it is necessary to take precautions:
- hold your laptops, tablets and other computers away from the case;
- avoid wearing jewelry around your neck ;
- favor them cotton clothes and not woolen or synthetic fabrics;
- don’t scratch (as far as possible);
- if one of the electrodes comes off, put it back as soon as possible ;
- avoid excessive physical activity causing excessive perspiration favoring the detachment of the electrodes
- do not take a shower or bath so as not to damage the device;
How to shower with a cardiac Holter?
You got it, Holter boxes are not waterproof. We therefore avoid washing, bathing or going to a sauna or hammam. Only option? The “cat toilet”, using a washcloth or specific wipes.
Can you do sports with a cardiac Holter?
The goal is to continue with usual activities and, if possible, to practice a gentle sporting activity (like cycling, running, yoga, etc). Avoid excessively strenuous activities, aquatic activities and all those that require removing the Holter.
How to sleep well with a cardiac Holter?
The ideal is to sleep on your back so as not to crush the electrodes and limit their detachment. Also prefer to wear clothes to keep the wires safe and limit entanglements. The ideal is to place the case in a pajama pocket or attach it to your top.
Note: for recordings of more than 48 or 72 hours, it is possible to change the electrodes every two or three days, according to the recommendations of the medical team. And in case of skin irritation, do not hesitate to shift them slightly at each rest to avoid the irritated area.
How and when to remove this device?
The Holter cannot be removed only after the preset recording time by the doctor (24 h, 48 h, 72 h, several weeks, etc.). Removal is simply peeling off the electrodes. The medical team is then responsible for collecting and analyzing the data collected.
Accuracy that matters: never try to turn off the recorder before the consultation dedicated to the removal of the device. A false manipulation, and all the data disappears…
The reading and analysis of the results depends on the duration of the recording and the noise present on the trace. The specialist will take care of determining the average, maximum and minimum heart rates and identifying any disturbances in conduction or heart rhythm.