Holter Monitoring and Arrhythmia Management

The ambulatory ECG (AECG) or Holter monitor has been available for decades. Historically, this device has been used to assess individuals with complaints of palpitations or with other signs or symptoms of frequent arrhythmia. Advancements in the field have expanded the use of AECG as a tool for assessing risk of sudden cardiac death (SCD). This discussion will address the presence and quantification of ventricular arrhythmias, long-term heart rate variability (HRV), heart rate turbulence (HRT), and modified-moving average T-wave alternans (TWA) and their use in noninvasive risk stratification for SCD. Emphasis will be placed on trial data and clinical utility of these measures along with a discussion of general challenges of non-invasive risk stratification.