Faris Basalamah,MD

InaHRS 2018

FKK Universitas Muhamadiyah Jakarta

RS Mitra Keluarga Jakarta
Each Holter model has its specific advantages with respect to
number of ECG channels :

 3 channels - Suitable for the detection of common heart rate and

conduction defects. It is however not possible to determine the place of
arrhythmia origin.

 7 channels – The QRS shape corresponds to the one obtained from

Resting ECG. Hence it has the same possibilities as 3 channels, but
even the place of arrhythmia origin can be determined (mainly due to
lead III).

 12 channels – The most comprehensive system, offers the same

possibilities as 7 channels and even a detailed ST segment analysis,
which can be used e.g. to diagnose silent ischemia. This system can
also be used to substitute the Stress-test examination.
 Premature Ventricle/atrial Contraction detection
◦ Frequency, Origin
 Tachyarrhythmia (NSVT, SVT) detection
 Brady arrhythmia detection
 Symptom related arrhythmia?
 Atrial fibrillation detection
◦ Diagnose, Therapy efficacy, Source of cryptogenic stroke
◦ Relief tool
 Ischemic detection
 Pacemaker/ICD evaluation
 Evaluation of SCD predictor
◦ HRV
◦ T wave alternans
◦ Late potential (SAECG)
The software allows one to change the analysis criteria. It is
possible to set the limits for Bradycardia, Tachycardia, Pauses etc.,
the physician can also change the alarm limits for PQ, ST, QT(c),
Prematurity levels, Pacemaker settings etc.

The PQ trend shows the PQ

interval development in time.

BTL CardioPoint-Holter
  Every Holter has a software module for ECG Holter record review and
analysis. The analysis is performed automatically and respects
patient’s demographics (age, gender, pacemaker presence, …). This
analysis can be later modified in the software.

Various screens
provide a different
look at the ECG
signal and various
diagnostic tools.

The software is
primarily operated
by means of
Navigation buttons
(all of them have
their equivalent on
the keyboard).

BTL CardioPoint-Holter
 The software distinguishes the homogenous and non-homogenous
templates. The homogenous templates are formed by beats with the same
shape and their representative beat is displayed in the template window. The
non-homogenous templates are formed by beats that may differ significantly,
they do not have their representative beat.
 With this division, the physician knows which templates should be verified
precisly (non-homogenous) and which do not need the verification
(homogenous).

Homogenous template (with its representative beat)

Non-homogenous template (message “Mixed

shapes” informs that the template can not be
represented by any beat)

BTL CardioPoint-Holter
 The Tiles view is an excellent tool for fast review of heart beat morphology,
especially when there are too many beats within one template and reviewing
them in the signal strip would be too time consuming. The tiles view can be
also used when reviewing the events (e.g. Max RR, Max HR, …)

In the Tiles View, each cell displays one

beat from the selected template. With
this view, the user can quickly review
large number of beats at once.
Move the slider to review all the beats
within a template.

BTL CardioPoint-Holter 8
Analysis Criteria

Cardiology Dept of BTL Indonesia 9

Alat diagnostik untuk menunjang Analisa Holter

Each pacemaker spike is clearly

marked in the ECG strip

Analysis Pacemaker yang canggih

The dispersion graphs show how

are the particular events
distributred in time.

Cardiology Dept of BTL Indonesia 10

  The Summary screen gives a clear overview of all important
cardiac events that were detected in the signal. Practically the whole
record can be reviewed and analyzed using this simple screen.

Summary The Summary table

screen contains the list of
cardiac events and
their corresponding
value (count).

Use the Navigation

buttons to browse the
events and correct the
invalid values if
necessary.

1
BTL CardioPoint-Holter 1
  CM5 (chest modified V5) is the most sensitif lead
that has sensitivity 89% in prediction of ischemic.*
 Addition of CM5 + CM3 increasing sentivity to 91%
and CM5+ inferior lead 94%.*
 CM5+CM3 + Inferior lead has 96% sensitivity to
predict ischemic.*
 Use of an inverse Nehb J lead, in which the positive
electrode is placed on the left posterior axillary
line, may enhance sensitivity to detect ischemia.**

*Lanza GA, Mascellanti M, Placentino M, et al. Usefulness of a third Holter lead for detection of myocardial ischemia.
Am J Cardiol 1994;74:1216 –9.
**Seeberger MD, Moerlen J, Skarvan K, et al. The inverse Nehb J lead increases the sensitivity of Holter
electrocardiographic monitoring for detecting myocardial ischemia. Am J Cardiol 1997;80:1–5.
The software offers a clear overview of all paced heartbeats.
Furthermore, it provides the user with the advanced analysis (such
as fail to capture, fail to sense, etc.). Thus, it can be used for
checking the correct functionality of the pacemaker.

Each pacemaker spike is clearly

marked in the ECG strip

The dispersion graphs show how

are the particular events
distributred in time.

BTL CardioPoint-Holter 13
 Very occasional: ≤10
 Occasional: 11 – 1499
 Moderate: 1500 – 2499
 Frequent: >2500
 Very frequent: > 25% of total beats

 60bpm x 60 minutes x 24hrs = 86400

beats per day
Sinus bradycardia
Chronotropic incompetence
 Inability for heart to > rate in relation to >
physical demand
 Fatigue/SOB
 SSS
 Very important each patient has one
 We check 5 minutes pre and post
documented time
 Confirm/rule out cardiac cause of
symptoms
 Noctural/diurnal bradycardia
 Patient exercising or cardiac arrhythmia??
Urgent discussion if…
 Sinus pauses >3 seconds

 Ventricular pauses >3 seconds

 Mobitz type II, 3rd degree AV block

 Diurnal heart rates <40bpm

 Sustained (>30secs) atrial fibrillation/flutter/ SVT

>120bpm
 Recurrent (>1 episode) ventricular tachycardia

 Prolonged (≥5 beats) ventricular tachycardia

 Irama dasar
 Kompetensi kronotropik
 Konduksi AV
 Tachyarrhytmia
 Bradyarrhytmia
 Segmen ST/Ischemic Detection
 Korelasi dengan keluhan
 Fitur khusus
  The BTL-08 Holter is produced in three models
allowing to record 3, 7 or 12 ECG channels.
5 leads, 3 channels 5 leads, 7 channels 10 leads, 12 channels

BTL CardioPoint-Holter
Kemudahan dan kecepat menganalisa rekaman Holter

Tiles View

Homogenous Templates

Cardiology Dept of BTL Indonesia 23

Kemudahan dan kecepat menganalisa rekaman Holter

Relief

Summary Screen
Waterfall

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 Kemudahan dan kecepat menganalisa rekaman Holter

Ventricular extrasystoles Pauses Low HRV Atrial Fibrilation

Pointcare

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Alat diagnostik yang canggih untuk menunjang Analisa Holter

Grafik Aktivitas Pasien

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 The user-interface can be fully customized to satisfy the user and his
needs. The user does not need to adapt to this software, the software
adapts to its user.

Example:

Default Template screen Modified Template screen showing the HR trend, graph
of patient’s activity and Full View ECG
BTL CardioPoint-Holter