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)
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Related Studies
| Definition (MSH) | Method in which prolonged electrocardiographic recordings are made on a portable tape recorder (Holter-type system) or solid-state device ("real-time" system), while the patient undergoes normal daily activities. It is useful in the diagnosis and management of intermittent cardiac arrhythmias and transient myocardial ischemia. |
| Concepts | Diagnostic Procedure (T060) |
| MSH | D015716 |
| SnomedCT | 164850009, 142012006 |
| English | Ambulatory Electrocardiographic Monitoring, Ambulatory Electrocardiography, Ambulatory Electrocardiography Monitoring, Dynamic Electrocardiography, Electrocardiographic Monitoring, Ambulatory, Electrocardiography Monitoring, Ambulatory, Electrocardiography, Dynamic, Monitoring, Ambulatory Electrocardiographic, Monitoring, Ambulatory Electrocardiography, Ambulatory ECG (regime/therapy), AMBULATORY ECG, ECG DYNAMIC, ECG MONITORING AMBULATORY, DYNAMIC ECG, ECG AMBULATORY, MONITORING AMBULATORY ECG, AMBULATORY ECG MONITORING, Electrocardiography, Ambulatory, ambulatory electrocardiography, Electrocardiogram ambulatory, Electrocardiogram;ambulatory, ambulatory ecg, Ambulatory ECG (procedure), Ambulatory electrocardiogram, Ambulatory electrocardiogram (procedure), Ambulatory electrocardiography, Ambulatory ECG, ambulatory electrocardiographic monitor, ambulatory electrocardiogram |
| Italian | Elettrocardiogramma ambulatoriale, Elettrocardiografia dinamica, Monitoraggio elettrocardiografico ambulatoriale, Elettrocardiografia ambulatoriale |
| Swedish | Långtids-EKG |
| Spanish | electrocardiograma ambulatorio (procedimiento), electrocardiograma ambulatorio (régimen/tratamiento), Monitorización Electrocardiográfica Ambulatoria, electrocardiograma ambulatorio, ECG ambulatorio, Electrocardiograma ambulatorio, Electrocardiografía Ambulatoria, Electrocardiografía Dinamica, Monitoreo Electrocardiográfico Ambulatorio |
| Japanese | ｶﾞｲﾗｲｼﾝﾃﾞﾝｽﾞ, 外来心電図, 心電図-歩行時, モニタリング-ホルター, 心電図-長時間, Holterモニタリング, 心電図-外来, 長時間心電図モニタリング, モニタリング-長時間心電図, 外来心電図検査, 動的心電図, 心電図-Holter, ホルター心電図, 心電図-ホルター, 歩行時心電図, ホルターモニタリング, 長時間心電図, Holter心電図 |
| Czech | holterovské monitorování EKG, elektrokardiografie ambulantní, Ambulantní elektrokardiogram |
| Finnish | Ambulatorinen elektrokardiografia |
| Russian | ELEKTROKARDIOGRAFIIA AMBULATORNAIA, AMBULATORNAIA ELEKTROKARDIOGRAFIIA, ELEKTROKARDIOGRAFIIA V DINAMIKE, MONITORING AMBULATORNYI ELEKTROKARDIOGRAFICHESKII, АМБУЛАТОРНАЯ ЭЛЕКТРОКАРДИОГРАФИЯ, МОНИТОРИНГ АМБУЛАТОРНЫЙ ЭЛЕКТРОКАРДИОГРАФИЧЕСКИЙ, ЭЛЕКТРОКАРДИОГРАФИЯ АМБУЛАТОРНАЯ, ЭЛЕКТРОКАРДИОГРАФИЯ В ДИНАМИКЕ |
| French | Monitorage continu de l'électrocardiogramme, Électrocardiographie dynamique, Surveillance ambulatoire continue de l'électrocardiogramme, Electrocardiogramme ambulatoire, ECG ambulatoire, Électrocardiographie ambulatoire |
| Polish | Elektrokardiografia ambulatoryjna, Badanie Holtera, Elektrokardiografia metodą Holtera |
| Hungarian | Elektrokardiogram ambuláns |
| Norwegian | Elektrokardiografi, ambulant, Elektrokardiografi, dynamisk, Langtids-EKG, Ambulant elektrokardiografi, Dynamisk elektrokardiografi, Overvåking av ambulant elektrokardiografi |
| Portuguese | Monitoramento Eletrocardiográfico Ambulatorial, Electrocardiograma ambulatório, Eletrocardiografia Ambulatorial, Eletrocardiografia Dinâmica, Monitorização Eletrocardiográfica Ambulatorial |
| Dutch | elektrocardiogram ambulant, Elektrocardiografie, ambulante, Elektrocardiografie, dynamische, Elektrocardiografieregistratie, ambulante |
| German | Holter-Elektrokardiogramm, Ambulante Elektrokardiographie, Elektrokardiographie, Langzeit-, Elektrokardiographie, dynamische, Elektrokardiographie, ambulante, LZ-EKG, Langzeit-EKG, Überwachung, ambulante, elektrokardiographische |
Ontology: Holter Monitors (C0182920)
| 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 |
