Research Studies

Diagnostic Yield of 24-Hour Holter vs 7-Day and 14-Day ePatch Extended Wear Holter

Purvee Parikh, CJ Grigoriadis, Alexandria Dunn, Vincent Norlock, Grant Gillstrom, Manish Wadhwa Philips ECG Solutions, San Diego, CA

Study on the Use of Holter Monitoring to Evaluate Heart Rate Variability (HRV) in Post-Myocardial Infarction Patients

Title: Heart Rate Variability as a Predictor of Mortality Following Myocardial Infarction: A Study Based on 24-hour Holter Monitoring

Objective:

The study aimed to determine if heart rate variability (HRV), as measured by 24-hour Holter monitoring, could be a useful predictor of mortality and adverse outcomes in patients who have survived a myocardial infarction (heart attack).

Methods:

Study Population: A cohort of patients who had experienced a myocardial infarction was monitored using 24-hour Holter devices within the first few weeks post-event.
Data Analysis: The Holter data was analyzed for HRV metrics, particularly time-domain measures such as the standard deviation of all normal-to-normal intervals (SDNN) and the root mean square of successive differences (RMSSD). Lower HRV is associated with higher sympathetic activity and reduced parasympathetic tone, both linked to poor cardiovascular outcomes.
Follow-Up: Patients were followed for a period of 2 to 5 years for mortality and cardiac events.

Results:

HRV and Mortality: The study found that reduced HRV (particularly SDNN < 70 ms) was a strong independent predictor of all-cause mortality and cardiac mortality during follow-up. Patients with low HRV were 4.1 times more likely to die from cardiac causes compared to those with higher HRV.
Prognostic Value: HRV, as derived from Holter monitoring, emerged as a valuable non-invasive tool for risk stratification in post-MI patients.

Conclusion:

Holter-based heart rate variability analysis provided significant predictive value for mortality after myocardial infarction. The study suggests that HRV assessment through 24-hour Holter monitoring could be an essential part of post-MI risk assessment protocols, helping clinicians identify high-risk patients who may benefit from aggressive management or closer follow-up.

Reference: Kleiger, R. E., et al. (1987). “Decreased Heart Rate Variability and Its Association with Mortality After Acute Myocardial Infarction.” American Journal of Cardiology, 59(4), 256–262.

Research Implications:

The study underscores the clinical importance of Holter monitoring for diagnosing hidden cardiovascular issues. It highlights the prognostic utility of HRV metrics derived from 24-hour Holter data in assessing long-term outcomes post-myocardial infarction. These studies are examples of how Holter monitoring informs not only diagnosis but also risk stratification and long-term management of cardiovascular patients.