Ambulatory monitoring devices, such as Holter and ABPM devices, collect and analyze long-term data. This facilitates the early detection of significant physiological events because if this test yields timely alerts, the cardiologist can act quickly and precisely. The popularity of ambulatory monitoring among healthcare professionals has ushered in a new paradigm in cardiac healthcare. In this article, we will delve into the details of this valuable tool, crucial for continuous long-term monitoring and the diagnosis of cardiac diseases.
What is a holter monitor?
In simple terms, it is an ambulatory electrocardiograph. Historically, electrocardiography began in 1897 with the work of Clement Ader’s string galvanometer, later modified in 1901 by Einthoven. The Holter monitor operates based on the galvanometer principle to record electrocardiographic signals from an individual engaged in their daily activities. The Holter, a pioneer in continuous monitoring, has come a long way since its inception in the 1960s. The first one weighed around 40 kilograms. Its inventor, the biophysicist Norman Jeffries “Jeff” Holter, mounted a bicycle with the heavy and cumbersome equipment on his back.
The holter monitor was introduced to the market in 1963, and since then, there has been an evolution leading to the development of increasingly smaller recorders, progressing from 1 to 12 channels. After continuous improvements and advances, the Holter is now the size of a small cell phone and provides two types of primary data for analysis. One is the QRS complex, and the other is the R-R interval. Conventional holters record continuously until detached from the patient or run out of power, although the standard monitoring time is 24-48 hours. We cannot overlook that the Internet, Wi-Fi, and broadband transmission, among other advancements, have brought the Holter monitor into the current digital era.
Clinical relevance. The utilization of the holter monitor has significantly increased, especially in detecting occult atrial fibrillation as a cause of cryptogenic stroke. Anticoagulation is always superior to antiplatelet therapy in the secondary prevention of stroke due to atrial fibrillation. Therefore, relying on the Holter monitor to diagnose occult atrial fibrillation and initiate anticoagulation can prevent recurrent strokes.
What is ABPM?
ABPM stands for Ambulatory Blood Pressure Monitor. The first person to measure blood pressure (BP) levels was Stephen Hales in 1733 by inserting a glass tube into a horse’s artery. Hales observed that the blood “would rise and fall at and after each pulse by 2, 3 or 4 inches.” Although this observation has been largely overlooked since then, it not only signifies the pulsatility of blood flow but also indicates the variable nature of BP levels.
ABPM refers to the recording of blood pressure, usually over 24 hours, to observe pressure variability patterns. This monitoring provides a superior and more precise assessment of true BP than standard one-time measurement. ABPM can detect circadian changes (diurnal rhythmic changes, including nocturnal dipping and morning surge) and BP variation in response to environmental and emotional changes experienced by the patient.
In addition, ambulatory blood pressure monitoring is a valuable tool for assessing the effect of antihypertensive therapy and predicting cardiovascular outcomes. Blood pressure is recorded every 15-30 minutes over the entire 24-hour period. According to the 2017 ACC/AHA guidelines, a normotensive patient should have daytime ABPM <120/80 mm Hg and nighttime ABPM <100/65 mm Hg. Although ABPM can detect very fine changes in BP variation in the circadian rhythm, the clinical significance of BP variability other than diurnal variation (such as beat-to-beat variation) remains uncertain.
Clinical relevance. In clinical practice, ambulatory blood pressure monitoring has diagnostic, prognostic, and therapeutic utility. Therefore, it remains the gold standard test to diagnose hypertension, including white coat, masked, and nocturnal hypertension. Ambulatory BP has been known to help start treatment of hypertension in patients with differential cardiovascular risks, including low-risk patients with white coat hypertension, or with high risk, including sustained hypertensive patients.
Other indications may include screening for obstructive sleep apnea, and in patients with postprandial heart rate variability and hypotensive symptoms, to rule out autonomic malfunction. For patients on treatment for hypertension, it can be useful in monitoring antihypertensive therapy, development of hypotensive symptoms on treatment, drug resistance, and correlation with office BP readings.
Now that we have discussed the clinical utility of these tools, it’s time to delve into the lightweight, comfortable, and powerful ambulatory monitoring tools that SCHILLER has developed.
medilog® AR
The medilog® AR Holter is an advanced, efficient, and reliable device. That’s why it’s perfect for routine clinical practice or for conducting advanced electrophysiology studies. Before we delve into its features in detail, let’s take a look at its anatomy:
Exclusive Features of SCHILLER. Our advanced Swiss quality technology allowed us to develop a device with astonishing capabilities:
- Pre-analysis of the trace on the recorder with true detection of the P-wave. The medilog® AR Holter records atrial fibrillation and atrial flutter in zero seconds, directly searching for P-waves, just like a cardiologist would.
- P-wave analysis. Our medilog® DARWIN2 software performs a true atrial analysis, allowing visualization of the P-wave formed in the atrium.
- Continuous recording for up to 14 days without changing the AAA battery and without recharging. Thanks to the dual-battery system, patients can be monitored for more than 14 days without the need to return to the clinic to change batteries.
- SpO2 detection (optional). Thanks to the recording of breaths derived from the ECG, the medilog® AR Holter can detect possible respiratory episodes during sleep. The optional SpO₂ sensor, connected via Bluetooth, allows for recording additional respiratory information.
medilog® DARWIN2 Software for medilog® AR Holter
It’s our sophisticated software, so powerful that it can directly detect atrial fibrillation through atrial analysis. medilog® DARWIN2 is an investment worth considering for many reasons that benefit the practice and income of physicians. To begin with, this sophisticated algorithm simplifies the interpretation of Holter studies because, among many other things, it allows:
- Reviewing morphologies by cascade or superposition, with easy Drag and Drop editing.
- Reclassifying morphologies in groups or individually.
- Noise directory that allows the user to review strips marked as noise and accept or include them in the analysis.
- Extraordinary accuracy in classifying normal or ventricular beats thanks to the medilog® ADAPT process.
All these features make it possible for the specialist to interpret a study in approximately 10 minutes. It is also possible to customize reports with the doctor’s name and the logos of their hospital or clinic to give them a more professional look.
From an economic standpoint, medilog® DARWIN2 is a one-time license purchase, so you have access to updates for free. It is also compatible with previous models of SCHILLER Holters. Finally, our ABPM BR-102 PLUS also uses medilog® DARWIN2, which means you can equip yourself with both types of ambulatory monitors without paying an additional software fee. Below, we explain its functionalities for ABPM.
BR-102 PLUS ABPM
BR-102 PLUS ABPM combines auscultatory and oscillometric measurements simultaneously, ensuring accurate readings every time. Before delving into further details about these blood pressure monitors, let’s explore its anatomy:
BR-102 plus features the following features:
- Comfortable cuffs in various sizes.
- Motion-tolerant technology that eliminates the need for re-inflation of the cuff and prevents inaccurate readings.
- Maximum comfort for the patient as the cuff inflates only to the necessary size.
- Integrated inflation pump that is nearly silent.
medilog® DARWIN2 for ABPM
The medilog® DARWIN2 software for BR-102 PLUS ABPM simplifies the work of cardiologists. Its functionalities include:
- Interpretative summary. Analyzes the patient’s blood pressure levels.
- White coat analysis. White coat hypertension is a phenomenon where a visit to the doctor makes patients so nervous that their blood pressure rises. medilog® Darwin2 allows distinguishing actual levels from those caused by external factors.
- Presentation of measurements in table form. A practical report that includes an interpretative summary, analysis of pressure drop during sleep, and statistics.
- Statistical analysis of blood pressure. All data in an easy-to-read format.
In short, medilog® DARWIN2 helps physicians generate reports quickly and analyze the data they need at a glance for issuing accurate diagnoses.
High-Performance Ambulatory Monitoring for Research and Diagnostics
SCHILLER’s Holter and ABPM systems are built to support both clinicians and researchers—whether diagnosing patients or conducting studies. Our solutions combine durability, precision, and user-friendly design to meet the highest standards in healthcare and clinical trials.
For Clinical Diagnostics. SCHILLER brings more than diagnostic accuracy—we offer Swiss-engineered innovation that enhances care in acute settings. Our solutions feature robust cybersecurity and seamless connectivity, helping streamline workflows, reduce administrative burden, and support cost-effective healthcare delivery.
For CROs and CLOs. Our ECG solutions equip contract research and clinical laboratories with cutting-edge technology for accurate, efficient cardiac assessments. With high-fidelity signal acquisition, advanced diagnostic algorithms, and multiple connectivity options—including USB, Bluetooth, and Wi-Fi—our systems deliver fast, reliable results tailored to the demands of clinical research.
Experience the Difference. Request a one-on-one session to discover the exceptional performance of SCHILLER’s ambulatory monitoring systems—and see how effortlessly they adapt to your clinical or research needs.
REFERENCES
[1] Wearable Devices for Ambulatory Cardiac Monitoring. Furrukh Sana et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316129/
[2] Holter Monitor. Ateeq Mubarik y Arshad Muhammad Iqbal. https://www.ncbi.nlm.nih.gov/books/NBK538203/#article-22971.s2
[3] The evolution of ambulatory ECG monitoring. Harold L Kennedy. https://pubmed.ncbi.nlm.nih.gov/24215744/
[4] Blood pressure and its variability: classic and novel measurement techniques. Aletta E. Schutte et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9017082/
[5] Ambulatory blood pressure monitoring in clinical practice. Apaar Dadlani et al. https://www.sciencedirect.com/science/article/pii/S0019483218305753?via%3Dihub#sec2
[6] Overnight pulse wave analysis to assess autonomic changes during sleep in insomnia patients and healthy sleepers” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7205215/
