The use of temporary atrial electrodes to improve diagnostic capabilities with Holter monitoring after cardiac surgery.

The use of temporary atrial electrodes implanted during cardiac surgery has been advocated for diagnosis and treatment of cardiac arrhythmias in the postoperative period. We have adapted this technique to allow continuous ambulatory electrocardiographic (Holter) recording of atrial activity in patients after coronary artery surgery. The electrodes of one of the two leads of the Holter recorder were attached as a surface electrocardiographic lead, while the electrodes of the other were each attached to one of the two implanted atrial wires. The Holter record was then obtained in the usual way. A satisfactory recording of the atrial electrocardiogram and the simultaneous surface electrocardiogram was obtained in all 6 patients and resulted in improved diagnostic capabilities, specifically in differentiating supraventricular and ventricular arrhythmia. As has proven to be true in the post-myocardial infarction setting, arrhythmias that were not noted clinically despite continuous electrocardiographic monitoring were demonstrated on Holter records.