Holter Interpretation

[aembry]

I have recently experienced a dramatic increase in palpitations. 25 yr old, female, normal echocardiogram & ekg. I have some concerns over my holter report. My doctor that I work for had me to wear it and I feel like he minimized the results just to ease my fears simply because he knew I was worried.

Here are results...

Total QRS Complexes: 117916
Ventricular Ectopics: 2635(2%)
Supraventricular Extopics: 90(1%)

Heart rate
Min: 52bpm
Max: 138 bpm
Avg: 83 bpm

Pauses: 12 pauses (>=2.0 seconds)
Longest: 5.9 secs
This is what has me most concerned. The dr told me that I had no pauses that it was all artifact. Im having a hard time believing that all 12 pauses was artifacts. Is that normal!? The report says Artifact: <1%

Ventricular Events
Isolateds: 2583
Bigeminal cycles: 49
Couplets: 21
Runs: 3
Longest run: 4 beats, 107 bpm
Fastes run: 4 beats, 107 bpm
Slowerst run: 3 beats, 86 bpm
Im freaking out about the runs, what does that mean!? Is that vtach?? Please tell me its not....

Supraventricular Events:
Isolateds: 7
Couplets: 7
Runs: 9
Longest: 20 beats, 92 bpm
Fastest: 5 beats, 103 bpm
Slowest: 7 beats, 88 bpm
Couls this be svt?

No ST depression or ST elevation. (What is this?)

[aembry]

What about when the ventricular runs are less than 100bpm, is that consider vtach, as I thought vtach was a beat of over 100bpm? Also is it possible that the runs could have been artifact, my doctor went as far as to say this wasnt real either.

[Joseph Sclafani, M.D.]

Hello,

Thank you for your question.

First, patients with no evidence of structural heart disease (normal echocardiogram) with ectopic beats (PVC's, PAC's, etc) have an excellent prognosis.

In regards to pauses. There is no way of knowing unless you ask your physician to show you the pauses. However, it is not unusual for the automated interpretation to call pauses when there was no pauses. One reason could be that you were not hooked up to machine at the time. That is why a human being must over read the automated interpreter. However, there is no way of knowing unless your physician shows you this.

In regards to runs. A run of PVC's >3 beats is called nonsustained V-tach. However, in a patient with no evidence of structural heart disease the importance of this in terms of prognosis is minimal in general.

In regards to runs of SV beats. Runs of SV beats with HR's<150 is not likely due to a true "SVT", as it not fast enough. Again, not likely of any clinical significance.

No ST segment elevation or depression is a normal finding. In means you had no changes on your EKG that are consistent with ischemia. This is a good thing.

Thank you,
Dr. S