Features of the standard report
- Predominant rhythm
- Important observations – pauses, sustained tachycardias etc
- Ventricular ectopics
- Supraventricular ectopics
- Bradycardias
- Any other arrhythmias
- Patient diary events
NB: a normal tape dose NOT rule out serious rhythm disturbance
Quantifying arrhythmias
- Total beats per day example
- 60 bpm x 60 minutes x 24 hours = 86400 beats per day
- Very occassional: <10
- Occasional: 11 – 1500
- Moderate: 1500 – 2500
- Frequent: >2500
- Very frequent: > 25% of total beats
Benign findings on tapes (generally)
- Sinus arrhythmia
- Sinus bradycardia or tachycardia
- Ectopics (VE or SVEs)
- Nocturnal conduction disturbances
- Very short arrhythmias (few beats of SVT or AF)
Red flags
- Complete heart block / 3rd degree AV block
- SVT > 120 bpm
- >1 episode of ventricular tachycardia
- >5 beats of ventricular tachycardia
- Sinus pauses > 3 seconds
- Ventricular pauses > 3 seconds
- Mobitz type 2
- Diurnal heart rates < 40 bpm
- Sustained ( >30 seconds) atrial fibrillation/flutter
Red flags in background
- Abnormal heart structure
- FH of unexplained sudden death
- Unexplained syncope