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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
24- or 48-hour ambulatory Holter ECG: This is the mainstay for identifying a rhythm disturbance. However, with intermittent symptoms, a 24- to 48-hour Holter monitor is often negative, although, occasionally, asymptomatic markers of the rhythm disturbance may be present (e.g. frequent atrial or ventricular ectopy, a tendency to long pauses or occasional ventricular ectopics).
Fibromyalgia Syndrome: Canadian Clinical Working Case Definition, Diagnostic and Treatment Protocols–A Consensus Document
Published in I. Jon Russell, The Fibromyalgia Syndrome: A Clinical Case Definition for Practitioners, 2020
Anil Kumar Jain, Bruce M. Carruthers, Maijorie I. van de Sande, Stephen R. Barron, C. C. Stuart Donaldson, James V. Dunne, Emerson Gingrich, Dan S. Heffez, Y.-K. Frances Leung, Daniel G. Malone, Thomas J. Romano, I. Jon Russell, David Saul, Donald G. Seibel
The work of Martinez-Lavin and coworkers (231) has associated heart rate regulation abnormalities with the trouble FMS patients have getting deep, restful sleep at night. Electrocardiograms of FMS patients suggest their basal autonomic state has increased sympathetic and decreased parasympathetic tones (384). The value of their ratio decreases markedly during the night in healthy normal controls but fails to fall among the FMS patients in a manner parallel to the trouble they experience with achieving deep sleep. A 24 hour Holter monitor can be used to evaluate the normal regulation of the heart rate with respiration over time. The relative contribution of the sympathetic nervous system acceleration of the heart rate compared to parasympathetic nervous system as they affect heart rate variability provides an assessment of autonomic nervous system regulation of the heart rate.
Ambulatory ECG recording
Published in Andrew R Houghton, Making Sense of the ECG, 2019
The 24-h ambulatory ECG recording (Holter monitor) is one of the most frequently requested investigations in the assessment of patients with a suspected intermittent arrhythmia. The recorder is carried by the patient on a strap or belt and records the ECG via a small number of electrodes applied to the skin. The recording is usually made digitally onto a flash memory card. After the device is returned, the recording is analyzed using appropriate software, looking for any rhythm disturbance.
The use of digital health in heart rhythm care
Published in Expert Review of Cardiovascular Therapy, 2023
Donald P. Tchapmi, Chris Agyingi, Antoine Egbe, Gregory M. Marcus, Jean Jacques Noubiap
These devices monitor cardiac activity using a patch attached to the patient’s skin instead of electrodes used in conventional devices. These waterproof patches can be attached generally for 7 to 14 days and up to 30 days, increasing recording time [2,14]. The patient can activate an event button on the device to mark the timing of symptoms [2]. Newer devices can transmit data to the cloud and enable almost real-time access by healthcare providers. Patches are also more expensive, which limits accessibility compared to holter monitors. Nonetheless, wearable patches outperform 24-hour Holter in arrhythmia detection when used over the traditional 14-day period [15]. Holter monitors have the disadvantages of producing more noise due to poor contact between skin and electrodes and a higher incidence of signal loss. Most patients prefer patches over Holter monitors because they are small and don’t have external electrodes. Local skin irritation can occur with patches but are usually mild and self-limiting [15,16]. Patches are an excellent option to determine the burden of arrhythmias – the proportion of time an individual spends in arrhythmia over the monitoring period – since they record an ECG continuously over 14 days [17,18].
Clinical electrophysiology of the aging heart
Published in Expert Review of Cardiovascular Therapy, 2022
Kyle Murray, Muizz Wahid, Kannayiram Alagiakrishnan, Janek Senaratne
External monitors, in order of increasing cost, include (1) Holter monitors, (2) event monitors, (3) patch monitors and (4) mobile cardiac outpatient telemetry (MCOT). In patients with symptoms every 1–2 days, a 24- to 48-hour Holter monitor can be used. Holter monitors are readily available and provide 3-channels of continuous ECG output. Over a 24-hour period, 25–50% of patients will report symptoms and 2–15% will have an actual arrhythmia [25]. Event monitors, historically known as loop recorders, are lightweight smaller devices applied to the skin overlying the heart and continuously record data for two weeks to three months. With symptoms, patients trigger an event, and a pre-specified, manufacture-dependent, duration of recording is saved. This is best utilized by patients with weekly to monthly symptoms. Event monitors diagnose clinically significant arrhythmias in 17–19% of triggered events [26,27]. Patch monitors are a single patch applied to the skin on the left chest, rather than multiple leads. They are less intrusive, but lasted only two weeks and recorded only a single lead. Patch monitors have comparable efficacy with less noise and signal loss [28]. MCOTs are 30-day single or 3-lead devices that are patient or device triggered. Events are transmitted real time via the cellular network to a monitoring center with the patient’s physician alerted immediately [27]. The choice of monitor will be dependent on frequency of symptoms, cost, and availability within your region
Subcutaneous cardiac rhythm monitors: state of the art review
Published in Expert Review of Medical Devices, 2021
Anish Nadkarni, Jasneet Devgun, Shakeel M. Jamal, Delores Bardales, Julie Mease, Faisal Matto, Toshimasa Okabe, Emile G. Daoud, Muhammad R. Afzal
One future consideration pertains to the growing options of wearable devices for monitoring of AF. The Apple Heart Study recently published data suggesting the Apple Watch was a feasible method to detect silent AF [38]. Technology such as Kardia, Apple Watch, FitBit all offer a less invasive option for rhythm monitoring; however, they have significant limitations when compared to SCRMs. While they do offer prolonged monitoring when compared to Holter monitors, these wearable devices provide only intermittent monitoring as opposed to SCRM’s that provide continuous, prolonged rhythm monitoring. While these wearable devices may have a role in outpatient rhythm monitoring in the future, as of now this technology is relatively new and the clinical accuracy of these devices is yet to be confirmed.