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Holter Monitor Results

Heart Rhythm Conditions | Last Active: 1 day ago | Replies (14)

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@marybird

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!

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Replies to "I've had a number of monitors over the years, ranging from an old fashioned Holter monitor..."

"...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.