What Prognostic Information Can We Get from Holter Monitoring in Patients with Heart Failure?

概要

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Sudden cardiac death is a major cause of morbidity and mortality in patients with heart failure. Studies have shown that prophylatic implantation of implantable cardioverter defibrillator (ICD) in some high risk patients could effectively reduce the mortality. Holter monitoring is a noninvasive easily-accessible modality that could help identify those high risk patients. Parameters derived from Holter monitoring including the presence of nonsustained ventricular tachycardia, frequent ventricular premature beat, impaired heart rate variability and heart rate turbulence have been shown to be able to help identify high risk patients but with unstatisfactory sensitivity and specificity. T wave alternans from Holter monitoring seemed promising but no solid evidence has been provided. Nonlinear analysis of the rhythms from Holter study such as muliscale entrophy is a new way to investigate the integrity of the autonomic system. Some pilot has demonstrated its feasibility and further study is needed.