The spectrum of Ambulatory ECG monitoring

Introduction

Since its introduction as a clinical investigative tool, the 12-lead electrocardiograph (ECG) has been the gold standard for recognition of cardiac arrhythmias. The resting 12-lead ECG, however, gives only a rhythm snapshot in time, whereas arrhythmias maybe short-lived, paroxysmal and even asymptomatic making
documentation in many patients very difficult. To overcome this, ambulatory ECG monitoring has been developed as a means of recording the ECG in patients over a set period of time, whether it be short-,medium- or long-term. With the miniaturisation of recording devices and advances in solid state technology, there has been a recent revolution in hardware design, so that the boundaries between these time dependent devices have become blurred. Not surprisingly, the indications for monitoring have broadened as the quality and range of monitoring devices have become available. In this review, the indications for ambulatory ECG monitoring with emphasis on non-arrhythmic indications such as ST segment analysis, heart rate variability, signal averaged ECGs, diurnal QT and QTc analysis, obstructive sleep apnoea and vectorcardiography will be discussed. Also, the types of electrode systems used, lead placement, monitoring hardware, data collection, analysis and presentation as well as cost effectiveness of the investigation will be covered.

Keywords Electrocardiography
Electrocardiographic monitoring

Download full article: http://dx.doi.org/10.1016/j.hlc.2017.02.034

Conclusions

Ambulatory ECG monitoring has been developed as a means of recording the ECG over a set period of time in patients suspected of having cardiac arrhythmias. In recent years, with the miniaturisation of recording devices and advances in solid state technology, the indications have broadened to encompass a wide spectrum of clinical situations and in particular, atrial fibrillation. The monitoring periods can be divided into short-, medium- and long-term studies with major hardware advances in all areas. Recently, there has been a resurgence of interest in other aspects of ECG monitoring such as ST segment analysis, heart rate variability,
signal averaged ECGs, QT analysis and obstructive sleep apnoea. All these new indications can be performed with a conventional 24-hour Holter monitor and algorithms are currently being developed, so that the necessary data can be presented in a standard format for interpretation. The value of each of these new indications has yet to be determined.