Holter Monitoring and Management
Management of cardiac events is dependent on the abnormalities identified via Holter or other monitoring methods of electrocardiography.
Syncope (passing out) and near-syncope (dizziness, light-headedness) are one of the official indications for Holter monitoring because they can indicate cardiac events such as those arising from arrhythmias or other cardiopulmonary disease. They are often accompanied by palpitations (the other official indication for Holter monitoring), nausea, visual blurriness, and unusual hearing effects.
For the most part, medical management of syncope, near-syncope, and palpitations that are discovered via Holter monitoring can be treated by replacing medication that has these side effects. There are antiarrhythmic drugs (beta blockers, etc.), but since these can create arrhythmic possibilities themselves, they are often begun in a hospital setting.
The following abnormalities can be addressed with an external pacemaker (temporary, outside of the body) or permanent (implanted):
- ● Bradycardia: contractions <40 beats per minute or sinus (autonomic pacemaker) electrical “pauses” > 3 seconds
- ● Atrioventricular heart block: In which the pacing atrial impulses are not passed successfully down the normal electrical conduit to effect synchronous cardiac activity and sustained, effective cardiac output
- ● Other electrical blocks within the ventricles that alter the normal pace making stimuli from the atria (sinoatrial “SA” node)
When there are serious, life-threatening arrhythmias (e.g., ventricular tachycardia), a “cardioverter-defibrillator” can be implanted under the skin that can administer an electrical shock to reboot the system when it senses a ventricular arrhythmia.
Many arrhythmias that are due to ectopic (abnormal or extra) pace making sites in the heart can be treated by destroying such areas with radio-frequency thermal ablation (destruction), targeted by imaging-directed catheters to the suspect site(s).