title: Relative importance of electrode placement over number of channels in transient myocardial ischemia detection by Holter monitoring.
abstract: To compare the efficacy of 3-channel ambulatory electrocardiographic monitoring (Holter monitoring) with 2-channel Holter monitoring in the detection of transient myocardial ischemia (TMI), channels CM2, CM5, and modified II were studied. Sixty patients with documented coronary artery disease underwent 48-hour Holter monitoring during their normal daily life, followed by exercise stress testing in the laboratory monitored by means of radionuclide ventriculography and standard 12-lead electrocardiography. Analysis revealed that 3-channel Holter monitoring identified 24 patients with a total of 205 TMI episodes and a total ischemic burden of 371.00 mV-min. By itself, CM2 would have detected only 3 patients (13% of the TMI population), 6 TMI episodes (3% of the total TMI episodes), and a 2.4 mV-min ischemic burden (0.7% of the total ischemic burden). Modified II alone would have identified 17 patients (71% of the TMI population), 160 TMI episodes (78% of the total TMI episodes), and 307.24 mV-min of the ischemic burden (82% of the total ischemic burden). The combination of CM5/modified II identified 23 patients (96% of the TMI population), 201 TMI episodes (98% of the total TMI episodes), and 370.44 mV-min of the ischemic burden (98% of the total ischemic burden). These findings suggest that the electrode placement is more important than the absolute number of channels in the detection of TMI by Holter monitoring.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina 27705, USA.
authors.forename: W
authors.initials: W
authors.lastname: Jiang
authors.forename: J A
authors.initials: JA
authors.lastname: Blumenthal
authors.forename: M W
authors.initials: MW
authors.lastname: Hanson
authors.forename: R E
authors.initials: RE
authors.lastname: Coleman
authors.forename: C M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: D
authors.initials: D
authors.lastname: Frid
authors.forename: J J
authors.initials: JJ
authors.lastname: Morris
authors.forename: R A
authors.initials: RA
authors.lastname: Waugh
mesh_terms: D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D004566:Electrodes; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D015635:Radionuclide Ventriculography; D013997:Time Factors