Phân tích Holter điện tâm đồ 24 giờ - Phạm Trần Linh

PHÂN TÍCH HOLTER 
ĐIỆN TÂM ĐỒ 24 GIỜ 
TS.BS. Phạm Trần Linh 
Viện Tim mạch – Bệnh viện Bạch Mai 
Email: ptlinhmd@gmail.com 
Kỹ thuật gắn điện cực 
Đầu ghi holter kỹ thuật số 
có 5, 7 hoặc 10 điện cực. 
5 điện cực ghi 3 kênh 
holter chuẩn phân tích: 
HRV, QT, RN, biến đổi sóng 
T, phát hiện máy tạo nhịp.& 
 7 điện cực ghi thông số 
như 5 điện cực và thêm: 
12-Lead ECG strips, 
10 điện cực tương tự như 
ghi ĐTĐ 12 chuyển đạo liên 
tục trong 24h. 
Bản ghi Holter rõ ràng, chất 
lượng phụ thuộc vào vị trí 
điện cực có được lau sạch 
hay không? 
Nên sử dụng Holter có từ 
5 điện cực trở lên. 
Cạo sạch lông và lau 
sạch da vị trí gắn điện 
cực. 
Sau khi chụp các dây dẫn 
đến các điện cực, làm 
một vòng tròn nhỏ với tất 
cả các dây dẫn và băng 
vào da của bệnh nhân. 
Kỹ thuật gắn điện cực 
Đọc 1 bản kết quả Holter như thế nào? 
• Phân tích tổng thể 
trong 24h. 
• NTT/T; NTT/N; 
ngừng xoang phải 
rõ ràng. 
• Có bản ghi tóm tắt, 
đa thông số và 
điện tâm đồ minh 
chứng. 
Tóm tắt kết quả 
Xu hướng nhịp tim trong 24h 
Phân tích đoạn ST 
ST chênh xuống < 1mm  BTTMCB 
ECG Strips 
Biến thiên nhịp tim 
Biến đổi ST 
Biến đổi ST 
H
ìn
h
 ả
n
h
 3
D
 b
iế
n
 đ
ổ
i 
S
T
Biến đổi ST theo từng thời điểm 
QT & QTc 
QT & QTc 
QT & QTc 
QT & QTc 
Atrial Fibrillation 
Pacemaker 
Pacemaker 
The Pacemaker report shows the following: 
 * Paced Beat Total 
 * Intrinsic Beat Total 
 * % Paced 
 * % Intrinsic 
 Pacemaker Failures: 
 * Failures to Capture 
 * Failures to Sense 
 * Beats < Lower HR Limit 
 * Beats > Upper HR Limit 
 * R-R Intervals > 1.5 seconds 
 Arrhythmia analysis for VE and SVE beats is 
performed on Intrinsic (normal) beats. The 
arrhythmia analysis includes VE Pairs, V-Runs, 
and SV-Runs. 
 All reported “Pacemaker Failures” should be 
immediately evaluated by a cardiologist. 
 Pacemaker recordings can be performed with 
either the 5 or 7 electrode Holter ECG recorder. 
Always review the Full Disclosure print-out for all 
Pacemaker patients. If additional ECG strip 
print-outs are desired, 
just tell us the times, and the additional ECG 
strips will be sent to you immediately. 
Chỉ định ghi Holter ĐTĐ theo AHA/ACC 
Crawford et al continued 
Indications for Symptoms related to Rhythm Disturbances 
 * Patients with unexplained recurrent palpitations. 
 * Patients with unexplained syncope, near syncope, 
 or episodic dizziness. 
 * Patients with episodic shortness of breath, chest pain, 
 or fatigue that is not otherwise explained. 
 * Neurological events when transient atrial fibrillation or 
 flutter is suspected. 
 * Cerebrovascular accidents without other evidence of 
 arrhythmias. 
Indications for patients without symptoms from arrhythmia 
 * Post-MI patients with ejection fraction < 40%. 
 * Congestive Heart Failure. 
 * Idiopathic hypertrophic cardiomyopathy. 
 * Sustained myocardial contusion. 
 * Systemic hypertensive patients with LV hypertrophy. 
 * Post-MI patients with normal LV function. 
 * Pre-operative arrhythmia evaluation. 
 * Patients with Sleep Apnea. 
 * Patients with valvular heart disease. 
Indications for Heart Rate Variability 
 * Post-MI patients with LV dysfunction. 
 * Congestive Heart Failure. 
 * Idiopathic hypertrophic cardiomyopathy. 
 * Post-MI patients with normal LV function. 
 * Diabetics to evaluate for diabetic neuropathy. 
 * Rhythm disturbances that preclude HRV analysis. 
Indications to assess Anti-arrhythmic Therapy 
 * To assess anti-arrhythmic drug response in 
 individuals in whom baseline frequency of 
 arrhythmia has been characterized as reproducible 
 and of sufficient frequency to permit analysis. 
 * To detect pro-arrhythmic responses to anti-arrhythmic 
 therapy in patients at high risk. 
 * To assess rate control during atrial fibrillation. 
 * To document recurrent or asymptomatic 
 non-sustained arrhythmias during therapy in the 
 out-patient setting. 
Indications for Pacemaker and ICD 
 * Suspected pacemaker or ICD failures. 
 * Post-operative evaluation of pacemaker and ICD 
Crawford, et al continued 
During the past decade, Holter ECG has been extensively 
used for the detection of myocardial ischemia. It is now 
widely accepted that Holter ECG monitoring provides 
accurate and clinically meaningful information about 
myocardial ischemia in patients with coronary disease. 
Indications for Ischemia Monitoring 
 * Patients with suspected variant angina. 
 * Patients with chest pain who cannot exercise. 
 * Pre-operative for vascular surgery who cannot exercise 
 * Patients with known CAD. 
 * Patients with atypical chest pain syndrome. 
 * Initial evaluation of patients with chest pain who are 
 able to exercise. 
The purposes of Holter ECG monitoring in pediatric 
patients include (1) the eveluation of symptoms that may be 
arrhythmia related; (2) risk assessment in patients with 
cardiovascular disease, with or without symptoms of an 
arrhythmia; and (3) the evaluation of cardiac rhythm after 
an intervention such as drug therapy or device 
implantation. Holter ECG monitoring is commonly used in 
the periodic evaluation of pediatric patients with heart 
Disease, with or without symptoms of arrhythmia. The 
rationale for this testing is the evolution of disease 
processes (such as long QT syndrome or hypertrophic 
cardiomyopathy). 
Indications for Monitoring Pediatric Patients 
 * Syncope, near syncope, or dizziness. 
 * Evaluation of hypertrophy or dilated cardiomyopathies 
 * Documented long QT syndromes. 
 * Palpitation after surgery for congenital heart disease. 
 * Evaluation of drug efficacy during rapid somatic 
growth 
 * Asymptomatic congenital AV block, nonpaced. 
 * Evaluate cardiac rhythm after anti-arrhythmic therapy. 
 * Evaluate cardiac rhythm after transient AV block 
 associated with heart surgery or catheter ablation. 
 * Evaluate rate-responsive or physiological pacing 
 function in symptomatic patients. 
 * Evaluate patient less than 3-years old with a prior 
 tachy-arrhythmia. 
 * Follow-up of complex ventricular ectopy on ECG or 
 exercise stress test. 
 * Evaluate suspected incessant atrial tachycardia. 
Chỉ định ghi Holter ĐTĐ theo AHA/ACC