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Dr. Andrew Rynne

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What do my Holter monitor test reports indicate?

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 5761 Questions

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Posted on Thu, 10 May 2018 in Hypertension and Heart Disease
Question: Hello Doctor,
I was recently diagnosed with frequent PVC.
I did one Holter recording in September and then another one now in December. Please help me understand the results between the two reports. Is there any reduction in the number of PVC? What is the significance of any differences between the 2 reports.

I have attached both old and new report and labelled it accordingly with this question. Thank you.
doctor
Answered by Dr. Ilir Sharka 55 minutes later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome back on HCM!

I carefully reviewed your uploaded Holter reports and would explain that PVCs have been reduced at 80% compared to the previous Holter report.

This means that your actual therapy has shown to be really successful in controlling PVCs.

Besides, all the PVCs are monomorphic, which means that they may originate by a localized arrhythmogenic focus in the myocardium.

Coming to this point, if you are tolerating well your actual therapy, as it is really effective, I would recommend continue taking it.

Otherwise, another treatment option would be cardiac ablation, based on the electrophysiological study, which would be able to localize of the arrhythmogenic focus in the myocardium.

You should discuss with your attending physician on the above issues.

I remain at your disposal for any further questions, whenever you will need!

Kind regards,

Dr. Iliri




Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 30 minutes later
Sorry for this follow up - I am just curious to know how you said the ectopics are down by 80%.

I am asking since the report actually shows that total ventricular beats are 12,755(12%) on the new report. Also on page 2 of report - the number of isolated ventricular beats per hour on the new report shows almost 12,391.

Also - the only medication I was on during the new Holter report was Restyl(Xanax). If the ectopics are reduced by this does this mean that they are linked to anxiety and not any other underlying cardiac issue?

Sorry if this is a stupid question. Please help me understand - thanks again for your time on this.
doctor
Answered by Dr. Ilir Sharka 6 hours later
Brief Answer:
I would explain:

Detailed Answer:
Hello again!

You should know that during Holter monitoring there are usually frequent artifacts which could be mistakenly considered as arrhythmic findings (ventricular or atrial ectopic beats).

This can be erroneously reflected also in Hourly Summary (page 2 of report).

In fact I was mentioning Ventriculars (V,F,E,I) and Atrial Beats (S,J,A) (on the first page of report), which are considered the most exact data after reviewing and clearing the preliminary arrhythmic events concluded by the Holter software (which in fact included both real arrhythmic events and artifacts).

Comparing these data, isolated PVCs are reduced to less than 20% in the last report (from 11717 to 2329).

You are right about anxiety; it may serve as a triggering factor for generating arrhythmic events in a predisposed individual.

Besides this, it is recommended performing additional lab tests for reviewing other potential triggering factors:

- thyroid hormones level,
- blood electrolytes level,
- fasting blood glucose,
- complete blood count,
- PCR & ESR

You have to discuss with your attending doctor on the above mentioned issues.

Hope you will find this answer helpful!

Regards,

Dr. Iliri




Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 10 hours later
Thank you doctor.

I have done all of the above mentioned tests. The only abnormality was in the thyroid levels that were around 5.5 - 6(TSH) with free T3 and T4 in the normal range. I have met an endocrinologist and they have suggested to not pursue treatment since all other parameters like body weight, mass, energy level etc. are ok.

From your interpretation on the holter report - since you mentioned that page 2 may erroneously represent the information., do you think I should check with the lab. Or should I consider this a valid report and be happy that I have an 80% reduction in PVC from before?

Please suggest. Thank you again ever so much!!! I would really like to tell you at this point that your constant support and help in getting these nagging questions answered is putting my mind at rest. You are really helpful doctor.
doctor
Answered by Dr. Ilir Sharka 14 hours later
Brief Answer:
Opinion as follows:

Detailed Answer:
Hello!

Regarding your Holter reports, I would rely on the written interpretations at the end of the first page on each test report:

It is stated that there are only monomorphic PVCs, no couplets, triplets, etc. no runs of VT (while on the second page the automatic Holter conclusion without the expert eye filtering has included some of them).

As it is observed, after filtering artifacts, there exists a reduction on the number of monomorphic isolated PVCs as I mentioned at the beginning of our thread.

Coming to this point, I would recommend following a healthy life-style (avoiding potential triggering factors of arrhythmia, like caffeinated and alcoholic drinks, controlling your level of stress and anxiety, etc.) and performing periodic medical followups by your attending cardiologist.

A Holter monitoring is recommended after six months, just to be sure that PVCs level is held at low levels.

Wishing you good health!

I remain at your disposal for any further health issue discussions in the future.

Best regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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