Diagnostic and prognostic values and limitations of Holter monitoring

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Abstract
The value of Holter monitoring in the management of arrhythmias is mainly related to the considerable amount of data it provides regarding arrhythmias and their determinants in spontaneous conditions. The rate dependence and the adrenergic dependence of arrhythmias are the two factors that have the most important electrophysiological, prognostic and therapeutic implications. The limitations of Holter monitoring are related less to technical than to theoretical problems. Both will progressively be solved. Three-channel recordings and digitization of the signal would assist processing and help exploit information about QRS morphology. Even more fruitful might be more extensive and comprehensive analysis of the interactions between the various factors responsible for the pattern and the severity of arrhythmias, for example, the preceding rate, pauses, the coupling interval and the repetitive activity. The prognostic implications of many arrhythmias may depend on the context of myocardial functional impairment and adrenergic stimulation.

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