12-lead vs 3-lead cardiac Holter - When is it recommended to carry it out? (Copy)

29 November 2021

The dynamic Holter ECG is the diagnostic method used to monitor the electrical activity of the heart over a period of time which often corresponds to 24-48 hours.
The 12-lead dynamic Holter ECG monitors and detects the origin of the arrhythmias, in particular of those with a ventricular origin, and it is very useful for the evaluation of cardiac ischemia and chest pain that occur only in certain conditions of life (1).

When is a 3-lead cardiac holter carried out?

According to Holter, the dynamic ECG (3-lead) (2) is usually carried out to detect cardiac anomalies such as:
• Arrhythmic anomalies;
• Ischemic anomalies;
These anomalies occur irregularly and therefore can hardly be detected by a simple resting ECG, which generally lasts a few tens of seconds and can be carried out for a maximum of a few minutes.
Other indications for the examination include the analysis of:
• Correct pacemaker function;
• Evaluation of the effectiveness of some drug, anti-arrhythmic and anti-ischemic therapies

When is a 12-lead cardiac holter carried out?
The most common circumstance to carry out a 12-lead cardiac holter monitoring occurs when we need to detect and evaluate ECG changes related to Brugata syndrome.
In general, according to Holter, a 12-lead cardiac holter is prescribed when a detailed view of the heart is needed (3).
Brugata Syndrome acts on a genetic basis and derives from an entirely electrical alteration of the heart.
We are referring to morphologically healthy hearts which, however, can be electrically vulnerable and predisposed to malignant arrhythmias and cardiac arrests.
This explains why this syndrome can provoke cardiac arrest even in young patients’ hearts, apparently healthy.
Even if Brugada syndrome diagnosis can be detected by a standard electrocardiogram, it can occur irregularly throughout the day.
This is why a 12-lead cardiac holter examination can be useful for detecting a spontaneous Brugada-type ECG over the course of 24 hours.

The new TeleECG monitors all the heart’s walls in greater detail, as it is able to record 12 leads for 24/48 hours.
Unlike the standard 3-lead ECG, this new device is provided with more electrodes and allows to “spy” and observe the heart in more detail and at a regional and anatomical level from several points.
The positioning of the electrodes is implemented by experienced and qualified personnel in the pharmacies.
The pharmacist will apply the precordial leads to specific points of the patient’s chest.
The collected data will be analyzed by expert cardiologists who will report the result and make it available in a few days in the pharmacy.

[1] Cardiologia dello Sport Diagnostica e clinica cardiovascolare - Gaetano Frajese, Massimo Fioranelli (2012)
[2] The use of a portable three-lead ECG monitor to detect atrial fibrillation in general practice - Anne N. Kristensen, Brintha Jeyam, Sam Riahi, and Martin B. Jensen (2016)
[3] 12-lead Holter electrocardiography. Review of the literature and clinical application update. Su L, Borov S, Zrenner B (2013)


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