How to report a Holter Monitor

A model conclusion:

"24 hour Holter monitor, good quality recording to assess patient report of x. Average heart rate xbpm with x% of the recording in sinus bradycardia and x% in sinus tachycardia. Maximum heart rate xbpm at 17:56 was a sinus tachycardia and minimum heart rate xbpm at 04:32 was a sinus bradycardia. Longest R-R interval of x seconds at 04:31 during sinus bradycardia. Rare isolated SVE. Frequent isolated ventricular ectopy, rare couplets and triplets. Patient symptom report of x correlated with isolated ventricular ectopy".

Useful phrases:

When you have a fast rhythm that looks like sinus but it is an old person:
"Likely appropriate sinus tachycardia. No patient events recorded at this time".


When you have a slow night-time sinus heart rate:
" Appropriate nocturnal sinus bradycardia with appropriate junctional/ectopic atrial escape as a result of vagal tone"
ttk: because vagal tone preferentially affects the SA node


When you have an ectopic without a P wave:
"Junctional beat with retrograde concealed penetration of the AV node, leading to the next sinus beat having the usual P wave morphology but a longer PR interval".

When you have an SVT where you see the P wave walk in and walk out of the T wave:
"Accelerated junctional rhythm for x beats with failure of the SA node to capture the ventricle"
OR
"Competing junctional and sinus pacemakers for x beats"

When you have long pauses at night in a patient with AF:
"Longest nocturnal pause in AF was x seconds".

When you have a seemingly long QT:
" A 12 lead ECG is recommended to assess the QT interval." (and add if patient on anti-arrhythmics)

When you have a broad complex relatively slow tachycardia without P waves visible:
" Period of tachycardia without discernable P wave. Cannot exclude slow VT in this patient on/not on anti-arrhythmics. Possible accelerate junctional rhythm with aberrancy. Unlikely to be AF as there is not enough difference in the R-R intervals".
OR
"Period of tachycardia without discernable P wave. Differential diagnosis includes accelerated junctional tachycardia with abberancy & slow VT. Unlikely to be AF as there is not enough difference in the R-R intervals".

When you are describing an SVT:
There are two types - "sustained" and "non-sustained".
You must describe three things:
a. Onset. The usual phrease will be "onset following PVC".
b. Duration in beats.
c. Speed.
It will be hard to describe the type, but the options are SIX:
- AT, AFL, AF, AJT, AVNRT, AVRT, .