Holter Monitor Information

Sometimes heart problems are extremely variable. When a pilot goes to his or her AME, an intermittent problem may not be detectable. The Holter Monitor scans cardiac rhythm activity over a longer period of time to try to capture any intermittent arrythmias (slow, fast or irregular heart rate activity) which could interfere with aviation or controlling duties. Like standard electrocardiography (ECG / EKG), the Holter monitor records electrical signals from the heart through a set of electrodes attached to the chest. The number and position of electrodes varies, but most Holter monitor models employ from three to seven electrodes. These are connected to a small piece of equipment that is attached to the patient's belt, and is responsible for keeping a log of the heart's electrical activity throughout the recording period.

Older devices use a standard C60 or C90 audio cassette that simply runs at a very slow speed to record the data. More modern units record onto digital flash memory devices. The data is uploaded into a computer which then automatically analyses the input, counting ECG complexes, calculating summary statistics such as average heart rate, minimum and maximum heart rate, and finding suspicous areas in the recording worthy of further study by the AME or heart specialist.

Electrodes should be placed over bones to prevent artifacts from muscular activity.

Both 24 hr and 30 day event recorders are available.

Event diary

In addition to wearing the device, most airman are asked to keep a diary of activities such as running and sleeping, symptoms, and times that their symptoms occur. This information is used by AMEs and there consulting cardiologists to rapidly pinpoint problem areas in the vast amount of data recorded during the monitoring period.

Note: Syncope (fainting), not satisfactorily explained or recurrent requires deferral (even though the syncope episode may be medically explained, an aeromedical certification decision may still be precluded). Syncope may involve cardiovascular, neurological, and psychiatric factors. AMEs will not immediately issue medical certificates if there are heart conditions that require deferral, or for any other cardiac condition that may result in sudden or subtle incapacitation. If the airman has one of these conditions, then the AME will consult with the FAA (AMCD) or the Regional Flight Surgeon. Medical documentation must be submitted for any of these cardiac conditions to support a possible waiver (special issuance) of an airman medical certificate.