Table of ContentsView AllTable of ContentsPurposeWhen It’s DoneRisksWhat To ExpectResults
Table of ContentsView All
View All
Table of Contents
Purpose
When It’s Done
Risks
What To Expect
Results
The Holter monitor test is the original, and still most widely used type ofambulatory electrocardiographic (ECG) monitoring.The main aim of a Holter monitor study is to analyze theelectrical activity of the heartoutside of the clinical setting—that is, as a person goes about their normal daily activities.
When a person has a Holter monitor test, they wear the monitoring device for either 24 or 48 hours, and the ECG recorded during this time is subsequently analyzed for anycardiac arrhythmiasthat might have occurred during the monitoring period, as well as for any signs ofcardiac ischemia.
The Holter monitor study is very effective in diagnosing cardiac arrhythmias, as long as they occur with sufficient frequency. The test is very safe.
The Holter monitor is named for Norman J. Holter, the physicist chiefly responsible for its invention in the 1950s.
What Does a Holter Monitor Detect?
A Holter monitor detects infrequent or fleeting cardiac arrhythmias.
There are many types of cardiac arrhythmias. They can produce various symptoms, and they differ tremendously in their medical significance and in their treatments.
If a person is suspected to have an arrhythmia, it is important to diagnose the precise nature of the arrhythmia in order to decide what, if anything, needs to be done about it. This means that the arrhythmia has to be captured on an ECG.
However, many cardiac arrhythmias occur only infrequently and completely unpredictably—and are often present for only brief periods of time. The odds of capturing one of these rare or fleeting arrhythmias while a healthcare provider happens to be recording a standard ECG (which records the heart rhythm for only 12 seconds) is quite small.
This is where the Holter monitor’s value comes in. By recording each and every heartbeat that occurs over a prolonged period of time, while a person goes about their activities of daily life, the odds of detecting one of these transient arrhythmias are greatly increased.
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When Should a Holter Study Be Done?
This being the case, most cardiologists do not often order a Holter study for this purpose, unless they are dealing with a patient who is known to have had silent ischemia—such as a person in whom silent ischemia was diagnosed on astress test, or who has had asilent heart attackin the past.
Risks and Contraindications
The Holter monitor study is virtually free of risk, except for a small chance of skin irritation at the site of electrode placement.
A Holter study is not always the best kind of ambulatory ECG monitoring to perform. If there is a good reason to believe that the arrhythmia you’re trying to diagnose is so infrequent that it is unlikely to occur in any given 24-48 hour period, a different type of ambulatory ECG monitoring that can be employed for weeks (or longer) should be considered.
Your healthcare provider will give you instructions before you have your Holter monitor test. Knowing these details before the test can help ease any fear or anxiety you’re experiencing.
Before the Test
Timing
You and your healthcare provider will decide together on a good time to do the test. Almost any 24-48 hour period will typically suffice, but it is best to pick a time when you are not traveling (to avoid hassles at airport security), are not planning water-based activities, or activities that will drench you in sweat (because you need to stay dry while wearing a Holter monitor).
Location
What to Wear
While you can wear any comfortable clothing, a loose-fitting top is required so that the Holter monitor can be comfortably worn underneath.
Other Preparation
You can eat and drink as you normally would prior to the test, and (unless your healthcare provider tells you otherwise) you can take your normal medication. It is a good idea to bathe before beginning a Holter monitor study, because you will be unable to do so while wearing the monitor.
Holter Monitor Test Cost
During the Test
Holter Monitor Electrode Placement
When you arrive at the Holter laboratory, a technician will place the electrodes (which are about the size of a 50-cent piece) at appropriate locations on your chest and attach them to the monitor.Men may have to be shaved in small patches in order for the electrodes to adhere properly.
The technician will help you decide how to wear the recording device, instruct you on do’s and don’ts, and will tell you how to keep a diary of your activities and symptoms. You will then be sent on your way.
Throughout the Test
During the test, you will simply follow your normal routine, with two big exceptions. First, you will need to keep the Holter equipment dry—so no showering, and no bathing of the chest area.
Second, you will need to keep a diary of all the activities you perform, and of any symptoms you may experience while wearing the Holter monitor. In particular, your healthcare provider will be most interested in symptoms of lightheadedness, palpitations, syncope, chest pain or shortness of breath. The precise time you experience these symptoms will be compared to the ECG recording at that moment.
You can exercise with a Holter monitor in place, but do only low-impact, light exercise. Vigorous workouts may cause inaccurate results. In addition, exercise that makes you sweat may cause the electrodes to detach, which can also interfere with the accuracy of your test.
Post-Test
When the test is finished, you will either return to the Holter lab to have the equipment removed, or will remove the equipment yourself, and return it (and your diary) via a delivery service the lab employs.
After the Test
It typically takes a week or two to get results from a Holter monitor test. Your healthcare provider will contact you to discuss the results and possible next steps.
If you experience skin irritation from the electrodes (which is uncommon), call the Holter lab to discuss what to do about it.
Holter Monitor Test Results
In interpreting the results of a Holter study, it is important to remember that the most common purpose of this study is to decide whether your unexplained symptoms are due to a cardiac arrhythmia—or not.This means that actually correlating symptoms to a simultaneous arrhythmia is critical to making the diagnosis.
A normal Holter monitor result will show no significant changes in the rhythm of your heart. Many people (most people, in fact) have occasional, benign types of arrhythmias that do not cause any symptoms at all.
Seeing such an arrhythmia on the Holter report, without simultaneous symptoms, indicates that this arrhythmia isnotcausing a problem, and (usually) does not require any treatment of further evaluation.
On the other hand, when symptoms are well-correlated with a cardiac arrhythmia, that’s an arrhythmia that is causing a problem (at the very least, it is producing symptoms), and that deserves to be addressed.
Your healthcare provider may also discuss with you other results shown on the Holter monitor report, including your maximum, minimum, and average heart rate, the total number ofpremature atrial complexes (PACs)andpremature ventricular complexes (PVCs)you may have had, and any episodes of possible ischemia.
If you are having a Holter study to look for silent ischemia, finding strong signs of ischemia on the test will likely lead either to further testing (perhaps with a nuclear stress test or a cardiac catheterization), or to a change in your anti-ischemia therapy.
Summary
The Holter monitor study is the most widely used type of ambulatory ECG monitoring. The test is quite good at diagnosing transient cardiac arrhythmias that generally occur during any given 24-48 hour period, and is very safe.
6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Barrett P, Komatireddy R, Haaser S, et al.Comparison of 24-hour Holter monitoring with 14-day novel adhesive patch electrocardiographic monitoring.Am J Med. 2014;127(1):95.e11-95.e17. doi:10.1016/j.amjmed.2013.10.003Cleveland Clinic.Heart Block Diagnosis and Tests.Nishijima D, Lin A, Weiss R, et al.ECG Predictors of Cardiac Arrhythmias in Older Adults With Syncope.Ann Emerg Med. 2018;71(4):452-461.e3. doi:10.1016/j.annemergmed.2017.11.014Ramkumar S, Nerlekar N, D’Souza D, Pol D, Kalman J, Marwick T.Atrial fibrillation detection using single lead portable electrocardiographic monitoring: a systematic review and meta-analysis.BMJ Open. 2018;8(9):e024178. doi:10.1136/bmjopen-2018-024178American Heart Association.Holter Monitor.American Heart Association.Premature Contractions - PACs and PVCs.Additional ReadingBarrett PM, Komatireddy R, Haaser S, et al. Comparison of 24-hour Holter monitoring with 14-day novel adhesive patch electrocardiographic monitoring. Am J Med 2014; 127:95.e11. doi:10.1016/j.amjmed.2013.10.003.Crawford MH, Bernstein SJ, Deedwania PC, et al. ACC/AHA Guidelines For Ambulatory Electrocardiography: Executive Summary And Recommendations. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the guidelines for ambulatory electrocardiography). Circulation 1999; 100:886.
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Barrett P, Komatireddy R, Haaser S, et al.Comparison of 24-hour Holter monitoring with 14-day novel adhesive patch electrocardiographic monitoring.Am J Med. 2014;127(1):95.e11-95.e17. doi:10.1016/j.amjmed.2013.10.003Cleveland Clinic.Heart Block Diagnosis and Tests.Nishijima D, Lin A, Weiss R, et al.ECG Predictors of Cardiac Arrhythmias in Older Adults With Syncope.Ann Emerg Med. 2018;71(4):452-461.e3. doi:10.1016/j.annemergmed.2017.11.014Ramkumar S, Nerlekar N, D’Souza D, Pol D, Kalman J, Marwick T.Atrial fibrillation detection using single lead portable electrocardiographic monitoring: a systematic review and meta-analysis.BMJ Open. 2018;8(9):e024178. doi:10.1136/bmjopen-2018-024178American Heart Association.Holter Monitor.American Heart Association.Premature Contractions - PACs and PVCs.Additional ReadingBarrett PM, Komatireddy R, Haaser S, et al. Comparison of 24-hour Holter monitoring with 14-day novel adhesive patch electrocardiographic monitoring. Am J Med 2014; 127:95.e11. doi:10.1016/j.amjmed.2013.10.003.Crawford MH, Bernstein SJ, Deedwania PC, et al. ACC/AHA Guidelines For Ambulatory Electrocardiography: Executive Summary And Recommendations. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the guidelines for ambulatory electrocardiography). Circulation 1999; 100:886.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Barrett P, Komatireddy R, Haaser S, et al.Comparison of 24-hour Holter monitoring with 14-day novel adhesive patch electrocardiographic monitoring.Am J Med. 2014;127(1):95.e11-95.e17. doi:10.1016/j.amjmed.2013.10.003Cleveland Clinic.Heart Block Diagnosis and Tests.Nishijima D, Lin A, Weiss R, et al.ECG Predictors of Cardiac Arrhythmias in Older Adults With Syncope.Ann Emerg Med. 2018;71(4):452-461.e3. doi:10.1016/j.annemergmed.2017.11.014Ramkumar S, Nerlekar N, D’Souza D, Pol D, Kalman J, Marwick T.Atrial fibrillation detection using single lead portable electrocardiographic monitoring: a systematic review and meta-analysis.BMJ Open. 2018;8(9):e024178. doi:10.1136/bmjopen-2018-024178American Heart Association.Holter Monitor.American Heart Association.Premature Contractions - PACs and PVCs.
Barrett P, Komatireddy R, Haaser S, et al.Comparison of 24-hour Holter monitoring with 14-day novel adhesive patch electrocardiographic monitoring.Am J Med. 2014;127(1):95.e11-95.e17. doi:10.1016/j.amjmed.2013.10.003
Cleveland Clinic.Heart Block Diagnosis and Tests.
Nishijima D, Lin A, Weiss R, et al.ECG Predictors of Cardiac Arrhythmias in Older Adults With Syncope.Ann Emerg Med. 2018;71(4):452-461.e3. doi:10.1016/j.annemergmed.2017.11.014
Ramkumar S, Nerlekar N, D’Souza D, Pol D, Kalman J, Marwick T.Atrial fibrillation detection using single lead portable electrocardiographic monitoring: a systematic review and meta-analysis.BMJ Open. 2018;8(9):e024178. doi:10.1136/bmjopen-2018-024178
American Heart Association.Holter Monitor.
American Heart Association.Premature Contractions - PACs and PVCs.
Barrett PM, Komatireddy R, Haaser S, et al. Comparison of 24-hour Holter monitoring with 14-day novel adhesive patch electrocardiographic monitoring. Am J Med 2014; 127:95.e11. doi:10.1016/j.amjmed.2013.10.003.Crawford MH, Bernstein SJ, Deedwania PC, et al. ACC/AHA Guidelines For Ambulatory Electrocardiography: Executive Summary And Recommendations. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the guidelines for ambulatory electrocardiography). Circulation 1999; 100:886.
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