Diagnostic results of 1 Vs 3 lead patch holters
By Prof Harry Mond
OAM I MBBS I MD I FRACP I FCSANZ I FACC I FHRS I DDU
I was recently asked about the differences between one and three channel ambulatory ECG monitor recordings and whether, one was superior to the other.
At Cardioscan, we always use and recommend three channel 24-hour Holter monitors to be sure about our diagnosis of arrhythmias. Anyone with experience with early model one channel event recorders will remember how useless those recordings were mainly because of artefact. We stopped reporting on one channel event recorders about two years ago.
The technology has changed
Traditional 3-channel holter monitors record continually for at least 24-hours and up to two weeks, usually requiring five electrodes on the chest. Models with fewer leads record fewer channels, whereas those with 7 or 10 leads can record 12-lead ECGs, which is useful for ventricular tachycardia.
A major advancement has been the development of the patch holter in which the electrodes are embedded. These also have a metal snap to which a V lead can be attached (for the third channel) using a standard electrode and cable. If this electrode/cable becomes detached, then the recorder automatically reverts to two channels of ECG data.
The patch electrode and monitor that Cardioscan uses is myPatch and allows two or three channels. When fully charged its battery can record for up to two weeks, although its major use is for 24hr to 3 day holter monitoring. Although relatively expensive, such patches are hopefully able to provide better quality recordings and can be used with activities such as swimming. Single channel recorders with patches have also become available, and hopefully will provide better recordings than in the past.
The question being asked; is one channel as good as three?
Since I was asked the question, I have reviewed the way I report three channel holter monitors and I strongly believe that three channels are much easier to report than just looking at one.
Firstly, each channel confirms the findings of the other making the report not only easier, but faster and probably more accurate. This is most certainly with atrial fibrillation.
Secondly, when there is artefact on one or more channels, there is hopefully enough information on one channel to prevent misdiagnosis.
Here’s a few examples
The arrhythmias in the next three Holter recordings are more difficult to diagnose and dependent on the three leads complimenting each other. There is at least one channel which is almost iso-electric and by itself gives very limited information.
These examples are seen every day with holter recordings and are not unusual studies. I have no doubt that even with improved technologies such as patches, three channel recordings are far superior to one channel.
Dr Harry Mond