Holter Monitor

by Michael_Koger

Ambulatory electrocardiography is a method to monitor an individual’s heart rhythm as well as signs and symptoms which may correlate with each other.

In 1949, Norman Holter, a biophysicist, created a method to monitor cardiac rhythm in those who were at home or other places. This was a wireless system to monitor clinical signs and symptoms as well as disturbances of the heart rhythm. The advantage of this procedure included observation for longer periods of time than with a traditional electrocardiogram. It explored diagnosis, prognosis, and arrhythmia assessment as well [1, 2, 3, 5].

Moreover, it has become possible to collect information about cardiac activity when patients are asleep, having sex, walking, or other activities. Of especial interest is the observation of malignant heart rhythms such as ventricular tachycardia. Others include atrial fibrillation, premature atrial contractions, and atrioventricular heart block. Obviously, the procedure is beneficial in patients who are at risk for sudden cardiac death [1, 2, 3, 4, 5].

Technology and Heart Disease

     This procedure has been in use for 70 years.  There are many varieties of it such as event recorder, external loop recorder, implantable loop recorder, and others.  The transmission of information with these devices may take place via Bluetooth, Wi-Fi, smartphones, and smartwatches.  There may be as many as 30 million Americans who wear a smart-technology device [1].

     There is also the use of ambulatory electrocardiography for determination of pacemaker adjustment.  In other words, malfunction of a cardiac pacemaker will assist the health care staff in decisions for clinical management.  Medication adjustment is another item which the clinician will consider with a Holter monitor [1, 2, 3, 4, 5]. 

     Moreover, one can examine the occurrence of dizziness, sensation of faintness, feeling of skipped heartbeats, and other observations which physicians can detect and manage [1, 2, 3, 4, 5].

Technician Management

     A technician with considerable knowledge about ambulatory electrocardiography will explain several things to clients.  Specifically, the patient must avoid magnets, metal detectors, high voltage areas, and microwave ovens.  They will also have to stay away from electric blankets.  The same is true for electric shavers and toothbrushes.  Nevertheless, there is no electrocution risk of the procedure.  Finally, he or she should place electrodes in their proper position [1, 2, 3, 4, 5].

     In any event, the data will never be complete unless the client keeps a diary of symptoms and daily activities.  This is where the clinician will assess occurrence of abnormal rhythms and their duration.  It will also demonstrate how these irregularities take place with activities such as eating, sleeping, exercise, dizzy spells, and other sensations [1, 2, 3, 4, 5].


     Progress with technology and medical knowledge has been phenomenal over the decades.  For example, diagnosis and management are quicker than they were during the 20th century.  Today, the health care team in general has remarkable ability to deal with these situations.


  1. Sanders, D., Ungar, L., Eskander, M., and Seto, A.  (2019).  Ambulatory ECG monitoring in the age of smartphones, Cleveland Clinic Journal of Medicine, 86, 483-493.
  2. American Heart Association.  (2015).  Holter monitor
  3. American College of Cardiology.  CardioSmart.  (2011).  Ambulatory electrocardiogram
  4. Heart Rhythm Society.  (2019).  Risk factors and prevention.
  5. Ioannou, K., Ignaszewski, M., and Macdonald, I.  (2014).  Ambulatory electrocardiography:  The contribution of Norman Jefferis Holter.  British Columbia Medical Journal, 56, 86-89.
  6. The photo shows a stethoscope and is reprinted with permission from U.S. Centers for Disease Control and Prevention.
  7. Copyright Michael Koger, Sr., M.D.  All rights reserved.


     The information contained in this article is for educational purposes only, and one should not use it for diagnosis or treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.

Updated: 08/10/2019, Michael_Koger
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Michael_Koger on 08/13/2019

Thank you.

blackspanielgallery on 08/13/2019

Current technology is the Kordia, which is a small device upon which two fingers are placed. It shows the graph of rhythm via cell phone, using a device, and for a fee an expert can read the ekg and report. It is a simple ekg, and costs about $100. The disadvantage is one must activate the device by holding two fingers on it for a very short period, about one minute.

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