The indications and technique for continuous ambulatory electrocardiographic recording in dogs - Veterinary Medicine
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The indications and technique for continuous ambulatory electrocardiographic recording in dogs
Holter monitoring is a practical but underused diagnostic test available to all practitioners. It can be used to diagnose and assess treatment of arrhythmias, detect cardiomyopathy, identify the cause of syncope, and measure the atrial fibrillation ventricular response rate during treatment.


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Because the electrodes are applied securely, removal can be challenging. We do not recommend using sharp utensils such as scissors and scalpel blades to remove the elastic tape; you might accidentally cut the leads or the patient. Instead, we recommend carefully applying acetone or a commercial tape adhesive solvent to the elastic tape and electrodes. Avoid contact with the Holter monitor and flash card. If you destroy the adhesive material first, Holter recorders can be removed safely and painlessly.

Holter monitor services

Holter monitors can be obtained from and the data analyzed by numerous Holter scanning services. Although these services use modern systems capable of arrhythmia analysis, remember that they are not designed for canine ECGs. Because of technical problems with recordings and in the analytic processes, fully automated computer scanning systems for Holter analyses are unreliable.5,6 We recommend services that analyze Holter recordings under the supervision of a technician or doctor who is familiar with the scanning computer and who is also competent in analyzing canine ECGs.

Some large commercial laboratories, such as Laboratory Corporation of America (Burlington, N.C.; 800-289-4358) and Biomedical Systems of Atlanta (Atlanta, Ga.; 800-877-6334), provide ambulatory ECG monitoring services. These diagnostic services will express- mail you a Holter recorder and all the ancillary equipment to apply the device to veterinary patients. After about 24 hours of recording, you then remove the recorder and mail it back to the service. The service will fax a summary of the recording to you and mail you a complete report within a few days. The cost to veterinarians is $140 to $150. You can request an evaluation by a veterinary cardiologist for an additional $50 to $100.

CONCLUSION

Continuous ambulatory ECG monitoring with a Holter monitor is a useful and practical diagnostic test available to all veterinarians. Holter recording is essential for the accurate assessment of arrhythmias and their treatment. It is the most sensitive test for detecting cardiomyopathy in Doberman pinschers and boxers, may be useful in determining the differential diagnoses in patients with syncope, and is underused as a means of determining the efficacy of atrial fibrillation ventricular response rate control. The application and removal techniques require attention to detail but are not difficult. Evaluation of the report by a veterinary cardiologist is available through commercial Holter monitoring services.

Justin D. Thomason, DVM, DACVIM (small animal internal medicine)
Department of Clinical Sciences
Center for Veterinary Health Sciences
Oklahoma State University
Stillwater, OK 74078

Tiffany L. Fallaw, BS, RVT
Clay A. Calvert, DVM, DACVIM (small animal internal medicine)
Department of Small Animal Medicine and Surgery
College of Veterinary Medicine
University of Georgia
Athens, GA 30602

REFERENCES

1. Holter NJ. New method for heart studies. Continuous electrocardiography of active subjects over long periods is now practical. Science 1961;134:1214-1220.

2. Marino DJ, Matthiesen DT, Fox PR, et al. Ventricular arrhythmias in dogs undergoing splenectomy: a prospective study. Vet Surg 1994;23(2):101-106.

3. Miller RH, Lehmkuhl LB, Bonagura JD, et al. Retrospective analysis of the clinical utility of ambulatory electrocardiographic (Holter) recordings in syncopal dogs: 44 cases (1991-1995). J Vet Intern Med 1999;13(2):111-122.

4. Goodwin JK. Holter monitoring and cardiac event recording. Vet Clin North Am Small Anim Pract 1998;28(6):1391-1407.

5. Hertel M, Kersten U, Mishcke R, et al. Long term ECG in dogs: comparison between computerized system and visual arrhythmia analysis. Berl Munch Tierarztl Wochenschr 1999;112:239-242.


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