Holter Tape Stretch

Report:

Sinus rhythm 68 – 70/min

Paper speed or stretch artefact

Comment:

Variable, in this case fast, paper speed prolongs all the formed elements of the cardiogram to make them look like the last four complexes in this recording. The prolongation is irregular, signifying this is not the usual doubling of the paper speed, from 25 to 50 mm/sec.

However, paper speed rarely (if ever) varies in the Holter readouts, directly selected and observed by the staff as they come out. This one was checked and the paper speed was normal.

The tape had been left on the patient too long – well over 24 hours – and the last part of the tape got stretched. This is little known artefact. So little known that one Cardiologist referred the old lady for a permanent pacemaker implant to another, who accepted her and had the Radiology Suite ready when I came to him with a copy of the recording made for me by the technicians and told him the diagnosis. The technicians knew what happened to the tape, but did not know how it was interpreted. He gave me an awkward laugh and said how I saved her thousands of dollars!

Below (Fig 92a) is a three-channel readout of the “escape rhythm”, again at 25 mm/sec.