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What Do My Holter Monitoring Test Results Indicate?
Question: I was recently diagnosed with AFIB. We did an Echocardiogram and stress test after the diagnosis. Everything came out normal/ well. To see if I needed to stay on blood thinners I wore a heart monitor for 48 hours. Everything seemed to be normal (I think). Here is one result:
1. For the 1st 24 hour period, the circadian pattern of sinus rate variability followed a blunted curve with HRs averaging 62 bpm during waking hours and 56 bpm during sleep.
2. For the 2nd 24 hour period, the circadian pattern of sinus rate variability followed a blunted curve with HRs averaging 61 bpm during waking hours and 60 bpm during sleep.
3. There was no evidence of high grade SA nodal block.
My question is, is a BLUNTED curve bad or abnormal? I am also on Multaq & Metoprolol to slow down my heart and adjust the heart rhythm. I was on these meds before wearing the heart monitor. Also would these meds create a blunted curve?
Can you please send your response to the following email:
YYYY@YYYY
The first email I sent you was my work email and I am leaving at this time.
By the way my report will state that I DID NOT fill out the diary while wearing the heart monitor. I did fill out the diary e.g. bed times, carrying groceries etc.
1. For the 1st 24 hour period, the circadian pattern of sinus rate variability followed a blunted curve with HRs averaging 62 bpm during waking hours and 56 bpm during sleep.
2. For the 2nd 24 hour period, the circadian pattern of sinus rate variability followed a blunted curve with HRs averaging 61 bpm during waking hours and 60 bpm during sleep.
3. There was no evidence of high grade SA nodal block.
My question is, is a BLUNTED curve bad or abnormal? I am also on Multaq & Metoprolol to slow down my heart and adjust the heart rhythm. I was on these meds before wearing the heart monitor. Also would these meds create a blunted curve?
Can you please send your response to the following email:
YYYY@YYYY
The first email I sent you was my work email and I am leaving at this time.
By the way my report will state that I DID NOT fill out the diary while wearing the heart monitor. I did fill out the diary e.g. bed times, carrying groceries etc.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully reviewed your Holter monitoring results and would explain that no any serious cardiac rhythm and conductance disorder is concluded.
Normal sinus rhythm is the persistent rhythm, without any detected sino-atrial and atrio-ventricular conductance abnormalities.
The "BLUNTED" heart rate response means that heart rate variability has not shown a wide range.
This does not necessarily means that an abnormality is present.
In your case, it is completely explained by the combined use of Multaq and Metoprolol.
So, nothing to worry about!
Coming to this point, I would conclude that you don't need anti-coagulation (blood thinners).
Hope you will find this answer helpful!
In case of any further uncertainties, feel free to ask me again!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully reviewed your Holter monitoring results and would explain that no any serious cardiac rhythm and conductance disorder is concluded.
Normal sinus rhythm is the persistent rhythm, without any detected sino-atrial and atrio-ventricular conductance abnormalities.
The "BLUNTED" heart rate response means that heart rate variability has not shown a wide range.
This does not necessarily means that an abnormality is present.
In your case, it is completely explained by the combined use of Multaq and Metoprolol.
So, nothing to worry about!
Coming to this point, I would conclude that you don't need anti-coagulation (blood thinners).
Hope you will find this answer helpful!
In case of any further uncertainties, feel free to ask me again!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. Iliri:
What a professional, detailed and fantastic response! I give you an A++.
Thank-you so much, XXXX
What a professional, detailed and fantastic response! I give you an A++.
Thank-you so much, XXXX
Brief Answer:
You are welcome!
Detailed Answer:
Hello again XXXX!
I am glad to have been helpful!
You can ask me directly at any time in the future if you will have any other uncertainties on the link below:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Best wishes,
Dr. Iliri
You are welcome!
Detailed Answer:
Hello again XXXX!
I am glad to have been helpful!
You can ask me directly at any time in the future if you will have any other uncertainties on the link below:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My arrhythmia doctor told me late last week during a visit that he wants me to do additional heart monitoring for 2 more weeks. This will be a month from now. He said that he wants more data. I wore the first heat monitor last week for 3 days. As you mentioned he told me that I probably did not need to be on blood thinners.
Why does he need more data? Isn't 3 days on the heart monitor really enough to get a good set of data?
Why does he need more data? Isn't 3 days on the heart monitor really enough to get a good set of data?
Brief Answer:
I would explain:
Detailed Answer:
Hello again, dear XXXXXXX
Regarding your concern on rhythm monitoring, I would explain that in general a 24 to 48 hours ECG monitoring (Holter) is sufficient when judging about the cardiac rhythm and any frequent cardiac arrhythmia.
But, as you are on anti-arrhythmic therapy (Multaq and Metoprolol) and with a previous history of atrial fibrillation, it is important to be sure about the effectiveness of the actual therapeutic strategy.
This means to investigate whether any rare episode of paroxysmal atrial fibrillation occurs, which is not possible to be caught in a standard Holter monitoring, thus requiring a longer cardiac rhythm monitoring several weeks to months.
As, you are a male younger than 65 years old, without a known history of hypertension, heart failure, diabetes, cerebral vascular or peripheral vascular diseases, with the actual cardiac rhythm status, it doesn’t seem to be any need for anti-coagulation (for stroke prevention according to CHA2DS2-VASCs score).
You can ask another follow up question free of charge (without extra pay) through this thread (there are three follow up questions allowed in every question).
Feel free to ask me about any other uncertainties!
Best wishes,
Dr. Iliri
I would explain:
Detailed Answer:
Hello again, dear XXXXXXX
Regarding your concern on rhythm monitoring, I would explain that in general a 24 to 48 hours ECG monitoring (Holter) is sufficient when judging about the cardiac rhythm and any frequent cardiac arrhythmia.
But, as you are on anti-arrhythmic therapy (Multaq and Metoprolol) and with a previous history of atrial fibrillation, it is important to be sure about the effectiveness of the actual therapeutic strategy.
This means to investigate whether any rare episode of paroxysmal atrial fibrillation occurs, which is not possible to be caught in a standard Holter monitoring, thus requiring a longer cardiac rhythm monitoring several weeks to months.
As, you are a male younger than 65 years old, without a known history of hypertension, heart failure, diabetes, cerebral vascular or peripheral vascular diseases, with the actual cardiac rhythm status, it doesn’t seem to be any need for anti-coagulation (for stroke prevention according to CHA2DS2-VASCs score).
You can ask another follow up question free of charge (without extra pay) through this thread (there are three follow up questions allowed in every question).
Feel free to ask me about any other uncertainties!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. Iliri:
Great response thank-you! The arrhythmia doctor took me off of Multaq a week ago. I am only on the Metoprolol. I do have high blood pressure by the way. It is very controlled with Guanfacine and the Metoprolol helps too. I am getting 117's/ 80's and lower at this time. So do you still feel that this/ your statement is true: "it doesn’t seem to be any need for anti-coagulation (for stroke prevention according to CHA2DS2-VASCs score)". My arrhythmia doctor did tell me that I did not really need to be on anti-coagulation drugs at this time even with the high blood pressure. I have been an athlete all my life. Competing in wrestling, bodybuilding and running. I workout very intensely (to failure) 2 times a week with weights (bodybuilding) training all body parts-upper and lower each session using very heavy weights and 4 times a week very intensely on the bike (aerobics) - 2 sessions at 30 minutes and 2 sessions at 45 minutes.
Great response thank-you! The arrhythmia doctor took me off of Multaq a week ago. I am only on the Metoprolol. I do have high blood pressure by the way. It is very controlled with Guanfacine and the Metoprolol helps too. I am getting 117's/ 80's and lower at this time. So do you still feel that this/ your statement is true: "it doesn’t seem to be any need for anti-coagulation (for stroke prevention according to CHA2DS2-VASCs score)". My arrhythmia doctor did tell me that I did not really need to be on anti-coagulation drugs at this time even with the high blood pressure. I have been an athlete all my life. Competing in wrestling, bodybuilding and running. I workout very intensely (to failure) 2 times a week with weights (bodybuilding) training all body parts-upper and lower each session using very heavy weights and 4 times a week very intensely on the bike (aerobics) - 2 sessions at 30 minutes and 2 sessions at 45 minutes.
Brief Answer:
It seems that anticoagulation is not necessary or mandatory.
Detailed Answer:
Dear XXXXXXX
As the only present component is hypertension then CHA2 DS2 - VASc score seems to be 1, which is considered “low-moderate” risk for stroke.
In such case an anti-platelet agent like Aspirin would be sufficient for cardio-embolism prevention.
So, anticoagulation doesn’t seem to be mandatory.
Furthermore, your persistent rhythm is normal sinus.
Even in the worst option, only a hypothetical paroxysmal atrial fibrillation episode could be registered by a more prolonged ambulatory ECG monitoring; and this does not change the above strategy.
My only advice is to keep properly controlling your blood pressure values; following a physically active life and a healthy life-style.
I would like to review your prolonged rhythm monitoring when it will be available.
Let me know about your test conclusions.
Regards,
Dr. Iliri
It seems that anticoagulation is not necessary or mandatory.
Detailed Answer:
Dear XXXXXXX
As the only present component is hypertension then CHA2 DS2 - VASc score seems to be 1, which is considered “low-moderate” risk for stroke.
In such case an anti-platelet agent like Aspirin would be sufficient for cardio-embolism prevention.
So, anticoagulation doesn’t seem to be mandatory.
Furthermore, your persistent rhythm is normal sinus.
Even in the worst option, only a hypothetical paroxysmal atrial fibrillation episode could be registered by a more prolonged ambulatory ECG monitoring; and this does not change the above strategy.
My only advice is to keep properly controlling your blood pressure values; following a physically active life and a healthy life-style.
I would like to review your prolonged rhythm monitoring when it will be available.
Let me know about your test conclusions.
Regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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