The History, Science, and Innovation of Holter Technology

Abstract

Holter technology has endured for more than 40 years, and proven to be a valuable adjunctive noninvasive diagnostic technology to record the ambulatory or long-term electrocardiogram in the study of living creatures. During this span of time, many scientists, physicians, and innovators contributed to the development and evolution of Holter technology. This essay seeks to document a view of the history and evolution of the technology during that time, and concomitantly give recognition to the scientists, physicians, and engineers who contributed so greatly.

2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry

“…Pioneering work by Norman "Jeff" Holter led to the first prototype of "mobile" cardiac telemetry device, requiring 85 pounds of equipment, worn on his back while riding a stationary bicycle and used a radio-ECG (circa 1947) (Del Mar, 2005;Kennedy, 2006). Modern AECG devices are light and inconspicuous, and through continuous beat-to-beat ECG monitoring, automatic arrhythmia detection and wireless transmission of data in near real time improve diagnostic yield and provide enormous improvements in efficiency and ease of use (Charitos et al, 2012;Hanke et al, 2009;Locati et al, 2016;Mittal, Movsowitz, & Steinberg, 2011;Reiffel, Schwarzberg, & Murry, 2005;Rosenberg, Samuel, Thosani, & Zimetbaum, 2013;Rothman et al, 2007;Vasamreddy et al, 2006).…”

Latency of ECG Displays of Hospital Telemetry Systems

“…Starting in the 1990s, digital telemetry systems allowed for computerized signal recording, storage, and retrieval. 5,6 As computing power increased, the networking capability of these systems increased, allowing for monitoring of electrocardiographic, hemodynamic, and other clinical data from multiple patients on a single networked system. By 2000, wireless communication in the hospital extended beyond telemetry systems, and the US Federal Communications Commission established a protected range of frequencies for wireless medical devices to minimize electromagnetic interference from other in-band radiofrequency sources.…”

2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry

“…Pioneering work by Norman "Jeff" Holter led to the first prototype of "mobile" cardiac telemetry device, requiring 85 pounds of equipment, worn on his back while riding a stationary bicycle and used a radio-ECG (circa 1947) (Del Mar, 2005;Kennedy, 2006). Modern AECG devices are light and inconspicuous, and through continuous beat-to-beat ECG monitoring, automatic arrhythmia detection and wireless transmission of data in near real time improve diagnostic yield and provide enormous improvements in efficiency and ease of use (Charitos et al, 2012;Hanke et al, 2009;Locati et al, 2016;Mittal, Movsowitz, & Steinberg, 2011;Reiffel, Schwarzberg, & Murry, 2005;Rosenberg, Samuel, Thosani, & Zimetbaum, 2013;Rothman et al, 2007;Vasamreddy et al, 2006).…”

“…There have been major advances in recording and signal processing techniques resulting in enhanced recording fidelity and more sophisticated analysis software (Kennedy, 2006).…”