Holter Monitor Results

The thing I noticed is that your symptoms occur when your heart rhythm and rate are okay, or at least that is how I, a lay person, interpret the results and comment.

Your monitor showed a variety of things going on, but not frequently, and I hope your doctor can explain. The fact that your ectopy/tach. are not frequent is probably why EKG's don't pick them up so I am glad you did the monitor.

I am not able to comment further on the results but others may chime in.

Ask your GP for a referral to a cardiologist! I wonder if they will order an echocardiogram or stress test to get more info.

You have some PACs, by the sound of it, although I haven't seen your ECG/monitor data. If your burden is less than about 3%, you needn't worry....except they can be highly intrusive and cause unease. IOW, the symptoms and resultant anxiety/fear are the two worst aspects of a sub-clinical case of PACs. From this point on, we can only guess what will happen over the next years. What we can hope, but against hope, is that your condition doesn't evolve to more significant numbers of PACs or other arrhythmia such as atrial fibrillation. I won't go on to suggest that the latter is likely, but....the literature does show that an electrically disordered myocardium does tend to evolve and to worsen over time.

The report is that you don't break rhythm....much. Your symptoms happen while you are in rhythm. I don't know how the arrive at this conclusion, one which you cite near the end of your post, because they have no way of knowing what you feel while the PACs are happening. You'd have had to furnish a log of events...which is usually asked of patients when they wear a Holter or equivalent so that events and symptoms/sensations can be matched temporally. If you did provide a blow-by-blow record of what you felt and noted the time, then I can see how they would know that you're still in NSR when the symptoms take place. What is uncertain to me is why there is a wide range of HR (Heart Rate), that being 56-126 BPM. Were you walking during the higher number of beats, or is this an unknown tachycardia. Your citation suggests no tachycardia is visible.

The patch monitor I wore had a button to push when I had symptoms or felt my heart do something.

@clwalker24 this may or may not apply but I often recommend the Afib Cure by Day and Bunch, two cardiologists. You don't apparently have afib but some of their suggestions might be of help. Lifestyle changes (diet, exercise, stress), addressing high blood pressure, weight and diabetes if present, and supplements are all mentioned. (I take magnesium which is reputed to calm things and drink low sodium V-8 for potassium (muscle cramps have stopped!).

Of course I have no way to know if those things have actually helped my afib but it isn't getting worse. I also have no way to know if those measures are at all relevant for you! @gloaming is the resident lay expert here...

Thanks for your reply about the button on your patch. I think that might be a lot more handy to elicit contemporaneous information for the person reviewing the patch's report. What would be lacking, though, is the 'qualitative' description of what the bearer of the patch is doing at the instant he/she feels the arrythmia beginning. Walking, only on stairs, only going down stairs with its accompanying jarring....? When lifting something heavy, belching after eating....you know all the triggers we talk about all the time. The descriptive data can tell more if the arrhythmia is related to exertion or Vagus nerve tone.

@gloaming I agree with you on the importance of linking symptoms with activity or other context. With both the Holter and Zio patch monitors I had to keep a log of what I was doing when I had symptoms. from the Zio website:

"2. Note any
heart symptoms
If you feel anything that you think might be unusual, press the top of the Zio patch. Then briefly describe it in the provided symptom log booklet or on the MyZio mobile app."

The actual report for Zio is quite thorough, assesses whether reports of symptoms match what is reported by the ECG. and provides details on when arrythmias occurred. https://www.irhythmtech.com/providers/zio-service/reporting (only the cover page of the sample report is accessible to us lay folks)

I always bring a list of triggers, whether long recognized or newly discovered, to MD's. My reports of symptoms always matches what is going on in my heart which gives me credibility I guess!

Thanks, that closes the loop for me. I have no experience except with the Holters, an aged and clunky tech if you ask me. They require one to keep a notebook on them with a pen or pencil and to record major events, such as going for a hike, or climbing stairs while carrying something, or even when eating. I would expect some, maybe many, to report entering AF shortly after imbibing alcohol of any quantity more than, say, a full ounce, or having a good-sized coffee that often seems to bring on the AF.

Thanks for the information.

I've had a number of monitors over the years, ranging from an old fashioned Holter monitor ( 2 days) to another type of monitor which I wore for 21 days, and finally two sessions with a ZIO monitor which I wore for 14 days each time. I've been informed that patient reported symptoms correlating with a recorded arrhythmic episode constitutes a positive test, while those symptoms reported at the time the monitor shows NSR is a negative test- ie, the symptoms likely caused by something other than a disordered heart rhythm. My first two monitor reports showed only a few PVCs and NSR, I wasn't symptomatic either. My first ZIO report ( think it was in 2017) verified my frequent tachycardic episodes as SVT, with heart rates up to 170 and some bradycardia showing heart rates in the 40's at times during the day. I think the SVT burden ( later identified by the EP as probable atrial tachycardia) was somewhere in the range of 15% or so, and the cardiologist tripled the dose of metoprolol, which helped. My symptoms matched the episodes of SVT on the monitor, so it was a positive test.

Several years later, while I still had episodes of tachycardia, the bradycardia became much more frequent, along with becoming more symptomatic ( lightheadedness, feeling as though I might pass out as my heart rate went into the low 40's and just wouldn't increase much over 50 even when I attempted normal daily activity, or even moderate exercise). The cardiologist ordered another ZIO monitor, looking for bradycardia, and this ZIO report showed some tachycardia still around, but also a number of episodes of bradycardia with the heart rate in the 40's and an average heart rate of 52 ( try washing windows or doing yard work, or cooking a meal with that- so frustrating!) I was referred to an EP, who recommended I stop the metoprolol for a couple months and take diltiazem instead ( to control the tachycardia and hopefully not cause bradycardia) to make sure the brady was not caused by the metoprolol. If this was not successful in controlling the tachy and not causing bradycardia, he recommended a pacemaker. The switch in medication was an epic fail, the diltiazem didn't control the tachy very well and I still had bradycardia, so I switched back to metoprolol ( which does help the tachy very well) and got the pacemaker. It's helped me immensely, I still take metoprolol for the tachycardia, and with remote monitoring of the pacemaker every 3 months it's like being monitored continually. I've also developed some afib over the last couple years, though the rate control drug ( metoprolol) and I think the regular pacing helps to control that. Now they know exactly when and how long my afib episodes occur, which is a good thing because I can't always tell when I'm having those. I started on Eliquis when they picked up the first several hours long episode of afib a couple years ago.

Windyshores, I recall keeping a log of my symptoms with the ZIO patch, though for my first one the episodes were so frequent I ran out of space on the log. I read the instructions and saw that they said the most important thing was for the patient to press the button on the ZIO patch even if they couldn't or didn't record the symptoms as that indicated the patient was aware of something happening with the heart rhythm, so I did a lot of that once I ran out of room on the log.

But as for the significance of a monitor report, I think it's really between the ordering physician and the patient. A 1% atrial tachycardia burden with the rest being NSR, or even an occasional PVC doesn't sound serious, but I think the patient's history and symptoms are important, and the intermittent nature of these arrhythmias are well known, might be that this time around the ugly arrhythmia monsters don't raise their ugly heads for the entire time the monitor is worn, but the minute it's taken off and returned, watch out!!! Doesn't mean that the patient does not have a problem, it just hasn't been caught yet. I recall mentally addressing my monster tachycardias just before I was to get one of the ZIO monitors- sort of pleading, I guess, that they show their ugly heads while I was wearing it, so we could figure out what was happening and if it was significant, should be treated, or were they insignificant in which case we could forget about them and never worry about them again. And boy, they accomodated my wish by showing up in spades for most of the two weeks I wore that monitor.
Anyway, to the OP, could luck with this!

Thank you for the responses. It is great to hear from others with similar issues. I will let everyone know the outcome of my appointment with my GP on Tuesday. I suspect he will refer me to a cardiologist.

"...they said the most important thing was for the patient to press the button on the ZIO patch even if they couldn't or didn't record the symptoms as that indicated the patient was aware of something happening with the heart rhythm..."

This is important. The reason is, even if there is only a cursory association between what the patient feels/senses and what the record shows at that moment, the patient's symptoms matter....a lot. Sometimes there is an 'idiopathic' set of symptoms that have no detectable cause. However, the symptoms, themselves, can quickly become a problem if they are so intrusive that they seriously and adversely diminish the quality of life of the bearer of those same symptoms. For physicians, the patient's well-being is exceedingly important, and should be sustained or improved as needs be. This is where the placebo effect can be instrumental in making the patient feel validated and listened-to. Or, a light drug that appears to offer a salutary effect and to restore the patient's calm and well-being is useful.

Depending on the arrhythmia and its frequency, the symptoms can be much more than being a just a problem in themselves, or diminishing the quality of life because the patient feels bad, and any drugs used to control the tachycardia are given just to placate the patient. I'd say the symptoms accompanying a frequent tachycardia ( such as my atrial tachycardia which before I took metoprolol would exceed 200 BPM, and my daughter's, which left her with a resting heart rate of 130, increasing to close to 200 with any activity) can well be indicative of compromised circulatory perfusion to any number of organs as a result of the tachycardia. Not to mention, of course, the effect of the tachycardia on the cardiac tissue itself, and tachycardia-related heart failure down the road if the tachy is not brought under control. Our daughter's EP informed us that if they could not bring her incessant tachycardia under control, she would die. She was prescribed an inordinate number of both anti-arrhythmic and rate control drugs but nothing worked for very long, she had a number of ablations, but the one that was finally successful was an epicardial approach via the thoracic cavity.

Symptoms associated with bradycardia are very important in determining the treatment of a patient with bradycardia. As the American Heart Association states in its guidelines for pacemaker implantation:

The term “symptomatic bradycardia” is used frequently throughout the guidelines and is defined as a documented bradyarrhythmia that is directly responsible for the development of frank syncope or near-syncope, transient dizziness or light-headedness, and confusional states resulting from cerebral hypoperfusion attributable to slow heart rate. Fatigue, exercise intolerance, and frank congestive heart failure may also result from bradycardia. These symptoms may occur at rest or with exertion. Definite correlation of symptoms with a bradyarrhythmia is a requirement to fulfill the criteria of symptomatic bradycardia.
https://www.ahajournals.org/doi/full/10.1161/01.cir.97.13.1325
Besides the ZIO patch testing I underwent to document symptomatic bradycardia, I was also quizzed pretty closely by both my EP and cardiologist as to the circumstances under which my symptoms appeared in association with the brady. They worried especially when might be driving, or operating machinery. The cardiologist asked me if I felt the symptoms ( light-headedness, slight shortness of breath) when I was resting, and seemed freaked out at my response-I didn't intend that! But my heart rate would often go into the high 30's when I was just sitting, and I told him "it felt cozy, like I could just go into nothingness, no thoughts, reactions, just nothing". Seems they had no problem recommending the pacemaker, with enough medication to control the atrial tachycardia, and now A-fib. It's worked very well for me, glad they didn't think I was a psych case that needed placating.