Understanding your Holter monitor report

All Holter monitor results are reviewed by an electrophysiologist (EP). An EP is a cardiologist who specializes in understanding the electrical functions of the heart. The EP who reviewed your data is called the “reading physician.”

The interpretation of the results involves considering various factors, including your medical history and medications. Any urgent findings will be communicated directly by your healthcare providers. All results of concern will be discussed in clinic follow-up.

What is the most important part of my results?

The most important part of the results is contained in the Summary/Comments or Conclusions of the Interpretation Summary. It notes the conclusions of the reading physician, which take into account why the Holter monitor was ordered for you. You will want to discuss these results with your healthcare provider as they will help determine the next steps in your care.

The results in MyChart are in two parts:

1. Interpretation Summary

• Titled: Scan – HOLTER MONITOR – # day – date 
• One to two pages long
• High-level overview of the results from the monitor

2. Detailed Report

• Length depends on how long you wore the monitor for: from 12 to 15 pages (for a 48-hour monitor report) to more than 30 pages (for a 14-day monitor report).
• Provides more details about the recording period

The Interpretation Summary gives you a high-level overview of your Holter monitor results. It may vary depending on the reading physician, but it typically includes:

• Longest RR: The longest pause between two heartbeats, in seconds.
• Average heart rate: Your average beats per minute during the recording.
• Minimum heart rate: The slowest heart rate recorded, and when it happened.
• Maximum heart rate: The fastest heart rate recorded, and when it happened.
• Ventricular beats: Extra beats from the lower chambers (ventricles). Also called ventricular premature beats (VPB), premature ventricular contractions (PVC), or ventricular ectopic beats.
• Supraventricular beats: Extra beats from the upper chambers (atria), but not from the sinoatrial node—the heart’s natural pacemaker, located in the right atrium. Also called supraventricular premature beats (SVPB), premature atrial contractions (PAC), atrial ectopic beats, or supraventricular tachycardia (SVT).
• SR (sinus rhythm): The percentage of time you were in sinus rhythm. Sinus rhythm refers to the heart’s normal rhythm, where beats come from the sinoatrial node.

The Symptom-Rhythm Correlation section matches the symptoms you recorded (using the buttons on the Holter monitor) to what your heart was doing at that time.

For example, the report could read:
Palpitations (x4): PACs/PVCs (x3), 3-beat NSVT (x1)

This means:

• Palpitations (x4): You recorded palpitations 4 times.
• PACs/PVCs (x3): Three of those times you had premature atrial or ventricular contractions.
• 3-beat NSVT (x1): One time you had 3 beats of non-sustained ventricular tachycardia.

The Detailed Report provides more information about the recording period.

In the Recording Information section, you will find:

• Start time: The time of day the monitoring began.
• Duration: How many hours the device recorded.
• Time analyzed: How many hours were reviewed by the reading physician.
• Average heart rate: Your average beats per minute over the monitoring period.
• Minimum heart rate: The slowest beats per minute recorded, and when it happened.
• Maximum heart rate: The fastest beats per minute recorded, and when it happened.

The General Summary section provides a more detailed overview of your heart’s activity, including:

• QRS complexes: The number of times the lower chambers of the heart (ventricles) get an electrical signal to squeeze and pump blood.
• Ventricular beats: Extra beats from the lower chambers (ventricles). Also called ventricular premature beats (VPB), premature ventricular contractions (PVCs), or ventricular ectopic beats.
• Supraventricular beats: Extra beats from the atria (upper chambers), but not from the sinoatrial node. Also called supraventricular premature beats (SVPB), premature atrial contractions (PACs), or supraventricular ectopic beats.
• Bradycardia beats: How often your heart rate was slower than 60 bpm.
• Tachycardia beats: How often your heart rate was faster than 100 bpm. May be reported as supraventricular tachycardia (SVT).
• Longest RR: The longest pause between two beats.
• Pauses: Delays in the heart’s electrical signal causing a pause in beating.

In the right column of the Detailed Report, you’ll see additional details if any abnormal patterns were detected:

• Ventricular premature beats:
  • Singles: one ventricular premature beat occurred.
  • Pairs: two ventricular premature beats occurred, one right after the other.
  • Runs: three or more ventricular premature beats occurred in a row.
  • Total beats in runs: total number of premature beats that occurred in runs.
• Supraventricular premature beats: Same details as above but for supraventricular premature beats.
• Atrial fibrillation (AF): Percentage of monitoring time showing AF (reported only if present).
• Atrial flutter: Reported only if detected during the monitoring period.

The General Profile section summarizes your heart’s electrical activity hour by hour:

• Interval starting: The time of day the interval started and the day.
  • 10:00am1 = 10 a.m. on day 1 of the recording.
  • Day 1 is the day you were fitted with the monitor.
  • The first and last interval are likely to be less than an hour, depending on when you put on and removed the device.
• Heart rate (Lo, Mean, HI): Slowest, average, and fastest heart rate in that hour.
• Total beats: Total beats recorded that hour.
• VPB Total, Pairs, and Runs VT: Ventricular premature beats (or PVCs) – total, pairs (two in a row), and runs (three or more in a row).
• SVPB Total and Pairs: Supraventricular premature beats (or PACs) – total, pairs (two in a row)
• Runs SVT: Supraventricular tachycardia runs (SVT) (three or more in a row).
• Pauses: Detected delays in the heart’s electrical impulse.
• Time analyzed: How much data was reviewed for each hour (e.g., 0:58 = 58 minutes).

The Heart Rate Trend section captures, in graphs, over the period of the recording, some of the data found in the previous section, including:

• Heart rate in beats per minute
• Ventricular premature beats per minute
• Ventricular beats per minute
• Supraventricular premature beats per minute
• Supraventricular tachycardia beats per minute
• Atrial fibrillation

The Full-Sized Strips section is a grouping of graphs. It captures specific patterns or what was happening during symptoms you reported on your Holter monitor. At the top of each “strip,” you will find:

• The time and day: For example, 2:19:16pm-4. This means 2:19:16 p.m. on the 4th day of the recording.
• The pattern/symptom: For example, symptom of skipped beat and pattern of premature ventricular contractions (PVC).
• HR: Heart rate is 76.

• Holter Monitors: PACE Cardiology (2 minutes): This video provides more information about why a Holter monitor is used.
• Electrical Conduction System of the Heart: Homework Clinic (3 minutes): This video provides more information about how your heart beats.
• Heart Conduction System and ECG: Siebert Science (20 minutes): This video provides a detailed overview of the heart's conduction system and the various components of an ECG, such as the Q, R, and S waves, as well as the QRS complexes.

The content has been prepared for general information purposes only and is not intended to provide specific medical or professional advice. The authors do not assume any liability or loss in connection with the information provided herein.