Procedure

Ambulatory EKG Monitoring

Ambulatory EKG Monitoring, Holter Monitor, Continuous EKG Monitor, Continuous ECG Monitor, Event Monitor, Transtelephonic Event Monitor, Patch EKG Monitor, Zio Patch, CAM Patch, Mobile Cardiac Telemetry, Electrocardiogram Event Monitoring, Ambulatory Electrocardiography, Ambulatory EKG

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

Diagnostics
Devices

Holter Monitor
1. Bulky, Continuous EKG Monitor worn for 24-48 hours
2. Patient keeps a diary of symptoms during monitoring
3. Continuous recording if episode occurs while monitored
4. Low yield given short duration (diagnostic in 10-15% of cases)
5. Indicated for daily symptoms (e.g. Palpitations)
Event Monitor
1. Small single lead device connected to worn continuous loop recorder for up to 1 month
2. Requires patient to push a button when symptomatic, and record a diary of events
  1. Event Monitor only saves recording when button pushed
  2. Records a few minutes before and after event
  3. May typically record up to 4 episodes
  4. Does not save tracings if Arrhythmia is asymptomatic
3. Indicated for weekly to monthly symptoms
4. Recordings transmitted via phone to lab for analysis
Patch EKG Monitor (Zio, CAM)
1. Single lead small device applied to chest for up to 14 days (without other monitor)
2. Single use device that may be worn during showering and Exercise
3. Indicated for weekly symptoms
Mobile Cardiac Telemetry
1. One to three lead external loop recorder transmits to portable receiver and uploads to internet
2. Provides realtime cardiac monitoring for up to 30 days
3. Indicated for weekly symptoms in higher risk patients
4. Similar devices are used on hospital telemetry wards
Implantable Loop recorders
1. Subcutaneous device implant records single lead for up to 36 months (limited by battery life)
2. Indicated in monthly symptoms, cryptogenic stroke, recurrent Syncope, Atrial Fib. following ablation
3. Highest yield device (diagnostic in 80-90% of cases, esp. for infrequent symptoms) but most invasive
Wearable SmartPhone Based Ambulatory Cardiac Monitors
1. Various consumer devices and software applications (e.g. Apple Smartwatch EKG, KardiaMobile)
2. Many of the devices are FDA approved for Atrial Fibrillation detection with high efficacy

Efficacy

Highest yield duration of monitoring is 14 days (diagnostic in 70 to 85% of cases)

References