AMBULATORY ECG MONITORS Flashcards
What is the primary purpose of ambulatory electrocardiography (AECG) monitoring?
To evaluate a suspected arrhythmia during normal daily activities and assist in diagnosis
AECG monitoring helps document the frequency, severity, and length of episodes, correlating them with symptoms like palpitations and syncope.
List the major indications for AECG monitoring.
- Unexplained syncope, near syncope, or episodic dizziness
- Unexplained recurrent palpitations
- Evaluation of pacemaker and ICD function
- Detection of undiagnosed atrial fibrillation (AF) in cryptogenic stroke
- Newly diagnosed nonischemic cardiomyopathy with suspected arrhythmia-induced ventricular dysfunction
- Evaluation of symptoms like palpitations or syncope caused by ventricular arrhythmias
- Monitoring accessory pathway conduction properties in Wolf-Parkinson-White syndrome
Indications are classified into Class I, IIa, and IIb based on the strength of evidence.
What are the different types of ambulatory ECG monitoring available?
- Holter monitors
- Event monitors
- Ambulatory telemetry
- Patch monitors
- Implantable loop recorders (ILRs)
- Commercially available smartwatches/wristbands
Each type has specific advantages and is chosen based on the patient’s symptoms.
What is a Holter monitor?
A device that continuously monitors and records ECG data for 24 to 48 hours, or up to 2 weeks with newer models
It is ideal for patients with frequent episodes occurring daily or every few days.
How does an event monitor operate?
Records ECG data for 30 to 60 days, storing events when the patient triggers it during symptoms
It captures data 1 to 4 minutes before and after the event.
What is ambulatory real-time cardiac monitoring?
A monitoring system that continuously records ECG data for 14 to 30 days, with real-time technician monitoring
This allows for immediate notification and treatment upon detection of an arrhythmia.
What are adhesive patch electrocardiographic monitors?
Monitors that self-adhere to the chest and can be worn for several weeks, transmitting data wirelessly
They typically provide a single ECG channel.
What is the function of an implantable loop recorder (ILR)?
An invasive device implanted subcutaneously for long-term ECG monitoring, recording events based on symptoms or heart rate
It has a battery life of 2-3 years and can yield a diagnosis in over 90% of unexplained syncope cases after 1 year.
True or False: Patients with pacemakers or ICDs always require Holter monitors for arrhythmia detection.
False
Most modern devices can detect and store arrhythmias, which can be reviewed upon device interrogation.
What types of arrhythmias might not be pathological during AECG monitoring?
- Sinus bradycardia during rest or sleep
- Sinus pauses <3 seconds while sleeping
- Wenckebach AV block
- Junctional escape complexes
- Premature atrial or ventricular complexes
These may be benign and not require treatment unless correlated with symptoms.
What percentage of healthy individuals may show ventricular arrhythmias during 24- to 48-hour Holter monitoring?
40% to 75%
The incidence increases with age but typically does not impact long-term prognosis.
What is the significance of frequent premature ventricular contractions (PVCs)?
They can lead to a form of potentially reversible cardiomyopathy if the PVC burden exceeds 15% to 20%.
PVC burden is the percentage of heartbeats that are PVCs rather than normal sinus beats.
Fill in the blank: The highest diagnostic yield for palpitations occurs within the first _______.
week
80% of patients receive a diagnosis during this period.
What is the role of commercially available smartwatches in ECG monitoring?
They use algorithms to analyze blood flow and identify arrhythmias like supraventricular tachycardia or AF
However, their positive predictive value remains suboptimal.
What is the significance of frequent PVCs detected by ambulatory monitoring?
Frequent PVCs can result in a form of cardiomyopathy, which is potentially reversible.
The PVC burden is the percentage of heart beats throughout the day that are PVCs rather than normal sinus beats. A burden surpassing 15% to 20% is associated with a significant reduction in left ventricular ejection fraction.
