Ambulatory ECG monitoring can identify patients who have electrical features that portend the development of ventricular fibrillation.Īlso associated with sudden cardiac death are the inherited channelopathies, a heterogeneous group of primary arrhythmic disorders without accompanying structural pathology. Similarly, Wolff-Parkinson-White syndrome, involving rapid conduction through an accessory pathway, is associated with increased risk of ventricular fibrillation and sudden cardiac death. This information is useful in assessing risk of sudden cardiac death and determining the need for an implantable cardioverter-defibrillator. Ambulatory ECG can detect premature ventricular contractions and ventricular tachycardia and identify their frequency, duration, and anatomic origin. This is particularly true in evaluating conditions associated with sudden cardiac death.įor example, hypertrophic cardiomyopathy and arrhythmogenic right ventricular dysplasia or cardiomyopathy are 2 cardiomyopathies that can manifest clinically with ventricular arrhythmias and sudden cardiac death. In a patient with known structural or electrical heart disease, ambulatory ECG can be used to stratify risk. Extended cardiac monitoring, lasting weeks or even months, is often needed for clinicians to make this diagnosis and initiate appropriate secondary prevention. Paroxysmal atrial fibrillation is a frequent cause of cryptogenic stroke, and because it is transient, short-term inpatient telemetry may not be sufficient to detect it. These factors are important when determining which device is most appropriate.Īmbulatory ECG can also be useful in looking for a cause of cryptogenic stroke, ie, an ischemic stroke with an unexplained cause, even after a thorough initial workup. The patient’s symptoms, family history, and baseline ECG findings can suggest a more serious or a less serious underlying rhythm. Others, such as atrial fibrillation, are more serious, and some, such as third-degree heart block and ventricular tachycardia, can be lethal.Īrrhythmia symptoms can vary in frequency and cause differing degrees of debility.
Some, such as premature atrial contractions and premature ventricular contractions, may be benign in many clinical contexts. Monitoring can be considered successful if findings on ECG identify risks for serious arrhythmia and either correlate symptoms with those findings or demonstrate no arrhythmia when symptoms occur.Ī range of arrhythmias can cause symp toms. The most common diagnostic role of monitoring is to correlate unexplained symptoms, including palpitations, presyncope, and syncope, with a transient cardiac arrhythmia. This article reviews the features, indications, advantages, and disadvantages of current devices, and their best use in clinical practice. Many ambulatory devices are available, and choosing the optimal one requires an understanding of which features they have and which are the most appropriate for the specific clinical context. Since then, advances in technology have led to small, lightweight devices that enable clinicians to evaluate patients for arrhythmias in a real-world context for extended times, often with the ability to respond in real time.
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3 By the 1960s, Holter monitoring systems were in full production and use. However, in 1952, Holter published the first tracing of abnormal cardiac electrical activity in a patient who had suffered a posterior myocardial infarction. 2Īt the time, it was uncertain if this technology would have any clinical utility. Furthermore, it could send a signal a distance of only 1 block. 1 His original device used vacuum tubes, weighed 85 pounds, and had to be carried in a backpack. Ambulatory ECG monitoring is commonly used to correlate symptoms with arrhythmia, confirm occult atrial fibrillation, and assess the efficacy of antiarrhythmic therapy.ĭevices have features such as access to the full monitoring time (“full disclosure”), extended monitoring, and telemetry, each with advantages and limitations.Ĭonsumer-oriented wearable devices are aimed at arrhythmia monitoring, which could lead to increased arrhythmia detection, but at the risk of more false-positive results and excessive use of healthcare resources.Ī mbulatory electrocardiography (ECG) began in 1949 when Norman “Jeff” Holter developed a monitor that could wirelessly transmit electrophysiologic data.
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