How is a Holter (Holter monitor) put on?

How to Apply a Holter Monitor

A Holter monitor is applied by placing adhesive electrodes on specific locations of the chest wall, which are then connected via external wires to a portable recording device that continuously records the heart's electrical activity over 24-72 hours while the patient performs normal daily activities. 1

What is a Holter Monitor?

• A Holter monitor is a portable, battery-operated device that provides continuous ECG recording for typically 24-72 hours (up to 2 weeks with newer models) 1, 2
• It allows for beat-to-beat acquisition of heart rhythm data while patients go about their normal daily activities 1, 2
• The device records and stores the ECG data for later analysis by technicians and cardiologists 2

Application Process

Preparation:

• Areas where electrodes will be placed are typically cleaned and may require some hair removal for better electrode contact 1
• The skin is usually prepped with alcohol to improve electrode adhesion 1

Electrode Placement:

• Multiple adhesive ECG electrodes (patches) are placed at specific locations on the chest wall 1
• Standard Holter monitoring typically uses multiple leads to capture different views of the heart's electrical activity 3
• The electrodes are connected to the recording device via external wires 1

Recording Device:

• The portable recording unit is typically worn on a belt or shoulder strap 1
• The patient is instructed on how to keep a symptom diary to correlate any symptoms with ECG findings 1
• Patients are shown how to mark events on the device when experiencing symptoms 1

Monitoring Duration and Patient Instructions

• Standard monitoring periods are 24-48 hours, though some newer devices can record for up to 7 days 1
• Patients are instructed to maintain normal daily activities while wearing the monitor 1, 2
• Patients should avoid showering or bathing during the monitoring period to prevent damage to the device 1
• Patients should maintain a diary of activities and symptoms to correlate with ECG findings 1

Limitations and Considerations

• Some patients may not tolerate the adhesive electrodes or the electrodes may not remain adherent throughout the monitoring period 1
• The diagnostic yield of conventional 24-hour Holter monitoring can be low (1-2% in an unselected population) if symptoms are infrequent 1
• Extended monitoring periods (48-72 hours) can significantly increase diagnostic yield, as demonstrated in studies showing 1.5-1.6 fold increase in detection rates with longer monitoring 4

Alternative Monitoring Options

For patients with very infrequent symptoms, other monitoring options may be more appropriate:

• External loop recorders (for symptoms likely to recur within 2-6 weeks) 1
• Patch recorders (2-14 days of monitoring with a leadless, water-resistant device) 1
• Mobile cardiac outpatient telemetry (up to 30 days) 1
• Implantable loop recorders (for very infrequent symptoms occurring over months to years) 1

When to Use Holter Monitoring

• Holter monitoring is most appropriate when symptoms are frequent enough to be detected within a short monitoring period (24-72 hours) 1
• It is indicated in patients with structural heart disease and frequent symptoms, or when there is a high pre-test probability of identifying an arrhythmia responsible for syncope 1
• It can be valuable for detecting arrhythmias that may be missed on standard ECG due to their intermittent nature 5