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Updated: Jan 19, 2026
Holter Monitor: 24-Hour Monitoring
Published on: June 19, 2025
Arrhythmogenicity of scuba diving: Holter monitoring in a hyperbaric environment
M P Boässon1, R Rienks2, A van der Ven3,4
1Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands.
Insights
Hyperbaric conditions at 50 msw did not cause clinically significant arrhythmias in professional divers. A minor PR interval prolongation was observed, unlikely to be clinically relevant for divers without pre-existing heart conditions.
Area of Science:
- Cardiology
- Hyperbaric Medicine
- Sports Physiology
Background:
- Diving fatalities are linked to cardiac disease, potentially involving fatal arrhythmias.
- Underlying cardiac conditions may be exacerbated by hyperbaric stress or exercise during dives.
Purpose of the Study:
- To assess the impact of hyperbaric conditions (50 msw) on cardiac conduction and arrhythmias in professional divers.
- Utilize electrocardiography (ECG) to monitor divers' cardiac responses under pressure.
Main Methods:
- Prospective study involving military divers undergoing hyperbaric exposure.
- Continuous ECG monitoring using Holter recorders during dives at 50 msw.
- Analysis of cardiac intervals (RR, PR, QRS, QT, QTc) and ectopy, comparing hyperbaric to resting conditions.
Main Results:
- 17 male military divers completed 20 dives.
- Observed ectopy included 10 premature ventricular contractions (PVCs) and 45 premature atrial contractions (PACs), with some atrial runs and pairs.
- Significant PR interval prolongation and QRS duration decrease noted at 50 msw.
- No significant changes in RR, QT, or QTc intervals were found.
Conclusions:
- No clinically significant arrhythmias were detected in divers under 50 msw hyperbaric conditions.
- A slight PR interval prolongation was observed, deemed not clinically relevant for divers without known conduction disorders.
Introduction:
About 26% of diving-related fatalities are caused by cardiac disease, part of which might be associated with fatal arrhythmias. This raises the question as to whether fatal arrhythmias are being provoked by hyperbaric conditions themselves or if exercise or stress provokes the fatal arrhythmias in cases of underlying (ischemic) cardiac disease.
Objective:
To measure the influence of hyperbaric conditions (50 msw) on cardiac conduction and arrhythmias in professional divers by means of ECG.
Methods:
This is a prospective study on military divers in a hyperbaric chamber with continuous ECG monitoring using Holter registrations. Supraventricular and ventricular ectopy was registered during hyperbaric conditions. RR, PR, QRS, QT and QTc intervals were calculated at 50 msw and compared with ECGs at rest.
Results:
Included were 17 male military divers who made 20 dives. A total of 10 PVCs, 45 PACs, four atrial runs and four atrial pairs were seen. Significant prolongation of the PR interval was seen and a decrease of in QRS duration at 50 msw. There was no significant change in the RR, QT and QTc intervals.
Conclusion:
In these divers, no clinically relevant arrhythmias were observed during wet dives in a recompression chamber at 50 msw. We observed a small prolongation of PR interval that is probably not clinically relevant in divers without any known conduction disorders.
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