Long-term ECG

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An episode of heart rate diagram of an LZ-ECG, which between 23:00 3:20 (bottom time axis) atrial fibrillation reveals

As a long-term ECG (abbr. LZ-ECG ) in which it is medicine to record the electrocardiogram over a longer period referred to by most 24 hours. After its inventor Norman J. Holter , the method is also known as the Holter EKG , especially in the Anglo-Saxon region .

The long-term ECG is used to evaluate the extent of cardiac arrhythmias and also to detect rare arrhythmias . The most common is the continuous ECG recording over 24 hours with the help of portable recording devices, which can also reveal circulatory disorders of the heart . Discontinuous recording using so-called event recorders or loop recorders is more rarely carried out over longer periods of time. Implanted event recorders, which are similar to pacemakers , also allow observation periods of several years.

Areas of application

Excerpt from a long-term ECG in nocturnal paroxysmal atrial flutter
Left: Atrial flutter
Middle: Sinus node arrest for approx. 2.7 seconds
Right: Onset of sinus rhythm

The conventional long-term ECG over 24 hours is mainly used to detect and quantify cardiac arrhythmias in patients with a known heart disease or with symptoms that could be caused by arrhythmias. These include palpitations , heart stumbling, attacks of dizziness , fainting spells ( syncope ) and temporary symptoms of paralysis ( TIA ).

In patients with atrial fibrillation or atrial flutter , the long-term ECG often reveals episodes of the arrhythmia that were not noticed by the patient himself, especially at night. After a heart attack or in the case of cardiac muscle diseases , especially with severely restricted pumping power of the heart, unnoticed life-threatening arrhythmias can also be discovered that require special treatment.

If the symptoms mentioned do not occur every day, the 24-hour long-term ECG often remains without any significant findings. In these cases, an event recorder can often help to identify or rule out cardiac arrhythmias as the cause. Every now and then, panic attacks and anxiety disorders can be assigned as consequences of a rhythm disturbance in this way .

In principle, an analysis of the ST segments to reveal circulatory disorders of the myocardium is also possible with considerable expenditure of time and at least three standardized recordings . Due to the limited informative value of the findings obtained in this way and improved other options, this analysis is only carried out in exceptional cases.

technology

Wiring for long-term ECG

Long-term ECG

The 24-hour long-term ECG is continuously transmitted to a cassette or hard disk recorder that is worn on the belt or around the neck via two to six electrodes attached to the chest. The older analog tape cassette devices are similar to a walkman and weigh around 150–220 grams. Modern devices store digitally on hard disks , CompactFlash memory cards or comparable storage media. They weigh around 100–120 grams and can be recorded for up to a week. After the end of the recording, the data is evaluated with the help of a computer, with an average of around 100,000 heart actions per 24 hours having to be analyzed.

Event recorder

Event recorder 60 mm × 48 mm × 28 mm with 200 h recording time

The use of the terms event recorder and loop recorder is not uniform. Event recorders are often small digital recording devices the size of a cell phone that are pressed by the patient on the skin in the chest area when symptoms such as palpitations or palpitations occur and then record an EKG episode for 30-60 seconds.

The event recorder can also function as a cell phone. The recorded ECG episode is then sent to an emergency call center via the GSM network. Before and after the transmission, the usual voice connection can be used to describe symptoms and for therapeutic advice; if necessary, the control center can determine the patient's whereabouts and alert emergency services.

Loop recorders, on the other hand, permanently record the ECG via skin electrodes, but usually delete it after 30 seconds. Only programmed special ECG events and ECG episodes marked by the patient by pressing a button are permanently saved. A plastic chest strap called Bluebelt with dry electrodes continuously records the ECG and, if certain ECG events occur, alerts an emergency call center via a Bluetooth connection and a relay or mobile phone, also via GSM network.

Implanted loop recorders can record ECG episodes over a period of one to two years without any appreciable impairment of the patient; these recorders are queried telemetrically . The devices are slightly smaller than pacemakers and are implanted under the skin above the heart. In contrast to the pacemaker, electrodes leading to the heart are not required. This means that the implantation can be carried out quickly and easily as part of an outpatient operation . These devices are used by people who are unable to put on the loop recorder during the episode, for example to clarify syncope or if previous examinations ( tilting table , ergometry, etc.) have not led to a result or if cardiac pathogenesis has to be ruled out .

Individual evidence

  1. ↑ R.Test ECG Patient Guide (PDF; 199 kB) Patient instructions for the R.Test 3 device

Web links

Commons : Holter EKG  - collection of images, videos and audio files