Continuous 12-lead electrocardiographic (ECG) monitoring can identify transient myocardial ischemia, even when asymptomatic, among patients with suspected acute coronary syndrome (ACS). In this article we describe our method for initiating patient monitoring using a Holter device, downloading the ECG data for off-line analysis, and how to utilize the ECG software to identify transient ischemia.
Total time
~24-48 hours (continuous monitoring period) plus ~1-2 hours analysis time
Steps
1
Prepare patient and attach Holter monitoring device
Clean skin sites and position the 12-lead ECG electrodes on the patient, then secure the portable Holter recorder for continuous monitoring. This establishes baseline electrical cardiac activity recording.
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2
Download and process ECG data for offline analysis
Connect the Holter device to a computer interface and transfer recorded ECG data to ECG analysis software. Prepare the dataset for systematic ST-segment evaluation.
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3
Identify transient ischemia using ECG software analysis
Utilize ECG analysis software to automatically detect and flag ST-segment deviations consistent with myocardial ischemia. Review software-generated reports highlighting transient ischemic episodes.
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4
Validate findings through independent clinical oversight review
Have a trained clinician independently review flagged ischemic episodes and software interpretations to confirm accuracy and exclude artifact. This manual verification ensures clinical reliability of automated detection.
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5
Interpret representative ECG tracings and outcomes
Examine de-identified representative ECG waveforms showing transient ST-segment changes and correlate with patient symptoms or silent ischemia. Document clinically significant findings.
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