A case study on how the portable ECG monitor identified tachyarrhythmia that holter monitor could not detect.
- Patient: 20-year-old male Chief
- Complaint: Palpitation, shortness of breath, chest pain
- Past History: WPW syndrome at 12 years old
- Case Presenter: Dr. Takashi Ashihara, Assistant Professor, Department of Cardiovascular Medicine, Heart Rhythm Centre Shiga University of Medical Science, Otsu, Japan
Since the patient suffered from vomiting and chest pains several times a year, he visited a paediatrician in Shiga University of Medical Science at the age of 12.
He was diagnosed with Type-B Wolff-Parkinson-White syndrome but he did not feel clear symptoms of palpitation. Although the paediatrician frequently ran electrocardiograms on him, no tachyarrhythmia was detected.
Recently he visited Heart Rhythm Centre of Shiga University of Medical Science since he came to feel palpitation once a week. Nevertheless, no tachyarrhythmia was detected by Holter monitor test conducted twice.
The patient was asked to take ECGs with the use of the Omron portable ECG monitor HOG801 for two weeks at times when he feels symptoms.
A week later paroxysmal supraventricular tachycardia of 200 bpm was recorded by the portable ECG monitor. The tachyarrhythmia was accompanied by palpitation, short breath, and chest pain.
A few weeks later, cardiac electro physiologic study was conducted and the uncommon-type atrio ventricular reciprocating tachycardia, propagating via an accessory pathway located at posterior wall of right ventricle, was identified.
The accessory pathway was disconnected by radiofrequency catheter ablation, and consequently the atrio-ventricular reciprocating tachycardia was permanently cured.
Dr. Ashihara's Comments
"It is necessary for us to confirm tachyarrhythmia on ECGs before we perform radiofrequency catheter ablation although a Holter monitor is usually used for patients with infrequent arrhythmias, we strongly recommend the use of Omron portable ECG monitor together with the Holter monitor.
"Actually, in our experiences, the portable ECG monitor could detect arrhythmias in 11 of 14 patients (79%) who noticed symptoms but whose arrhythmias were not detected by the Holter monitor.
"The average length of time until the portable ECG monitors detected symptomatic arrhythmias was 3.2 days (up to 12 days). We additionally found that the quality of life of the patients was apparently improved since the portable ECG monitors provided them a sense of security."