II. Indications
- Nondiagnostic EKG and high suspicion for Arrhythmia
- Structural heart disease
- Family History of Sudden Cardiac Death
- Inherited channelopathy (e.g. Long QTc Syndrome)
- Syncope or Near Syncope
- Palpitations
III. Diagnostics: Devices
- Holter Monitor
- Bulky, Continuous EKG Monitor worn for 24-48 hours
- Patient keeps a diary of symptoms during monitoring
- Continuous recording if episode occurs while monitored
- Low yield given short duration (diagnostic in 10-15% of cases)
- Indicated for daily symptoms (e.g. Palpitations)
- Event Monitor
- Small single lead device connected to worn continuous loop recorder for up to 1 month
- Requires patient to push a button when symptomatic, and record a diary of events
- Event Monitor only saves recording when button pushed
- Records a few minutes before and after event
- May typically record up to 4 episodes
- Does not save tracings if Arrhythmia is asymptomatic
- Indicated for weekly to monthly symptoms
- Recordings transmitted via phone to lab for analysis
- Patch EKG Monitor (Zio, CAM)
- Single lead small device applied to chest for up to 14 days (without other monitor)
- Single use device that may be worn during showering and Exercise
- Indicated for weekly symptoms
- Mobile Cardiac Telemetry
- One to three lead external loop recorder transmits to portable receiver and uploads to internet
- Provides realtime cardiac monitoring for up to 30 days
- Indicated for weekly symptoms in higher risk patients
- Similar devices are used on hospital telemetry wards
- Implantable Loop recorders
- Subcutaneous device implant records single lead for up to 36 months (limited by battery life)
- Indicated in monthly symptoms, cryptogenic stroke, recurrent Syncope, Atrial Fib. following ablation
- Highest yield device (diagnostic in 80-90% of cases, esp. for infrequent symptoms) but most invasive
- Wearable SmartPhone Based Ambulatory Cardiac Monitors
- Various consumer devices and software applications (e.g. Apple Smartwatch EKG, KardiaMobile)
- Many of the devices are FDA approved for Atrial Fibrillation detection with high efficacy
IV. Efficacy
- Highest yield duration of monitoring is 14 days (diagnostic in 70 to 85% of cases)
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Medical Device (T074) |
| SnomedCT | 86184003 |
| English | Holter Monitors, Recorders, Long-Term, ECG, Portable, Electrocardiographic monitor and recorder, device, holter monitors, holter monitor, holters monitor, Electrocardiographic monitor and recorder, Holter monitor, Electrocardiographic monitor and recorder, device (physical object) |
| Spanish | monitor Holter, monitor y registrador electrocardiográfico (objeto físico), monitor y registrador electrocardiográfico |
Ontology: Continuous ECG monitoring (C0420200)
| Concepts | Therapeutic or Preventive Procedure (T061) |
| SnomedCT | 266706003, 182804003, 151131007 |
| English | Continuous ECG monitoring (regime/therapy), continuous electrocardiogram monitoring, continuous electrocardiogram monitoring (procedure), continuous ECG monitoring, ECG monitoring (& continuous), ECG monitoring (& continuous) (regime/therapy), Continuous electrocardiogram monitoring, Continuous electrocardiogram monitoring (procedure), Continuous ECG monitoring, Continuous ECG monitoring (procedure) |
| Spanish | control electrocardiográfico continuo, control ECG continuo, control electrocardiográfico continuo (procedimiento), control electrocardiográfico continuo (régimen/tratamiento) |
Ontology: Electrocardiogram event monitoring (C2242517)
| Concepts | Diagnostic Procedure (T060) |
| English | Electrocardiogram event monitoring |
| Spanish | Monitorización ambulatoria de evento arrítmico |
| Dutch | monitoring van voorval op elektrocardiogram |
| German | EKG-Aufzeichnung mittels Event-Recorder |
| Japanese | ｼﾝﾃﾞﾝｽﾞｲﾍﾞﾝﾄｶﾝｼ, 心電図イベント監視 |
| Czech | Monitorování příhody EKG |
| Portuguese | Monitorização de eventos por electrocardiograma |
| Italian | Monitoraggio elettrocardiografico |
| French | Monitorage d'événements par électrocardiogramme |
| Hungarian | Electrocardiogram esemény monitorozása |
