Ambulatory ECG (AECG) is very commonly employed in a variety of clinical contexts to detect cardiac arrhythmias and/or arrhythmia patterns which are not readily obtained from the standard ECG. Accurate and timely characterization of arrhythmias is crucial to direct therapies that can have an important impact on diagnosis, prognosis or patient symptom status. The rhythm information derived from the large variety of AECG recording systems can often lead to appropriate and patient specific medical and interventional management. The details in this document provide background and framework from which to apply AECG techniques in clinical practice, as well as clinical research.
Ambulatory ECG monitoring; event monitor; Holter; loop recorder; telemetry; transtelephonic
Ambulatory ECG (AECG)1 telemetry is typically used to evaluate symptoms such as syncope, dizziness, chest pain, palpitations, or shortness of breath, which may correlate with intermittent cardiac arrhythmias. Additionally, AECG is used to evaluate patient response to initiation, revision, or discontinuation of arrhythmic drug therapy and to assess prognosis in specific clinical contexts. The purposes of this statement were (1) to review how contemporary AECG devices
acquire and process ECG signals and how they should be interpreted; (2) to review appropriate utilization of these devices in the management of cardiovascular disease; and (3) to promote standards that will improve the accuracy and appropriate use of the AECG in clinical practice.
The writing group recognizes that technical details of the processing and recording of AECGs may be unfamiliar to some clinicians. Accordingly, a major purpose of this document was to provide clinicians with insight concerning current technology and its implications for clinical interpretation. Moreover, evolving technologies permit integration of cardiac data with other monitored variables, extending traditional applications.
This document builds upon previous published professional society guidelines from 1999 to 2009 (Brignole et al., 2009; Crawford et al., 1999; Drew et al., 2004;
Kadish et al., 2001), and focuses most intently on the evolution and advancement of AECG technology and its impact on clinical decision making practice.