: Adamec Jan, Adamec RichardЖанр
Описание: With the ECG Holter the issue is no longer just to detect an arrhythmia, but also to determine dynamic circumstance in which the critical event occurred. In fact, we investigate the trigger, the event, and the context, and we have to integrate all of that information within the clinical picture, from the pathology right through to the symptom—indeed a multi-dimensional task.
In this volume the practice of 24-hr ECG recording is elucidated in detail, including discussion of the technical bases of the recording and the potential artefacts. There is a risk of wrong conclusions because of an excess of data. Avoiding errors in the data analysis is impossible without the assistance of IT (information technology), which means that we have to rely on an automatic interpretation, at least in terms of a preliminary triage.
Rightly, great interest is attributed to the formal analysis of the ECG, but one should be cautious about overemphasising the findings. It has been wrongly concluded for too long that trivial arrhythmias, as, for example, isolated ventricular premature beats, may trigger complex arrhythmias. Wrongly, it has been assumed that pharmaceutical suppression can inhibit ventricular tachycardias and fibrillation, and this false association has dominated the rhythmology and the therapy of tachycardias for several decades. Nowadays, though, there is a concensus that the trigger of dangerous arrhythmias cannot be identified without knowing the specific substrate. Therefore, these authors have to be acknowledged for not having correlated the exact electrocardiographic analysis with the therapeutic need for treatment.
The 24-hr ECG is designed to relate symptoms to electrocardiographic signs. Typically though, symptoms only rarely correlate with arrhythmias. This finding may reassure an anxious patient and help to forestall further expensive investigation. On the other hand, indications for heart disorders may be detected that justify further complementary investigations. In this context the recording take on a prognostic value—and hereby we return to Tibetan medicine.
The efficiency of therapeutic intervention, such as the treatment of atrial fibrillation or the implantation of pacemakers or defibrillators, can be surveyed. The present Holter guide focuses on the exact conventional ECG analysis and leaves the way open to new analytical methods such as frequency variability and QT-variation.
Only through clear-cut clinical demand and precise data analysis will the ECG Holter contribute to the diagnosis and therapy instituted. Otherwise, the technique will dominate the diagnostic, which we would like to avoid. Rightly, Jan and Richard Adamec remind us to be cautious regarding these risks, and in so doing they underscore their extensive practical and clinical experience in exposing the highly complex, but overall transparent, method of N. J. Holter.