Name of the Procedure:

External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review, and interpretation.

Common Names:

• Extended Holter Monitor
• Ambulatory ECG monitoring

Summary

This procedure involves using a portable device to continuously record the electrical activity of the heart for an extended period, typically between 48 hours and 21 days. The collected data is later analyzed to detect abnormal heart rhythms.

Purpose

External electrocardiographic recording is used to diagnose irregular heart rhythms that may not occur during a standard ECG test. The data helps healthcare providers:

• Monitor the effectiveness of heart treatments.
• Diagnose conditions like arrhythmias.
• Assess symptoms like palpitations or unexplained fainting spells.

Indications

• Frequent palpitations
• Unexplained dizziness or fainting
• Suspected arrhythmias
• Post-surgical monitoring for heart conditions
• Evaluating the effectiveness of heart medications or treatments

Preparation

• Patients may need to wear loose-fitting clothing to accommodate the monitor.
• Certain skincare instructions may be given to ensure proper electrode adhesion.
• Patients are typically advised to maintain their usual activities to capture typical heart activity.
• An initial ECG may be performed to establish a baseline.

Procedure Description

1. Setup: Electrodes are placed on the patient's chest and connected to a portable recording device.
2. Monitoring: The device continuously records heart rhythms while the patient goes about their daily activities.
3. Logging: Patients may be asked to keep a diary of symptoms and activities during the recording period.
4. Data Retrieval: After the monitoring period, the device is returned, and the data is downloaded.
5. Analysis: Data is scanned and analyzed for abnormal heart rhythms, with a detailed report generated.
6. Review and Interpretation: A healthcare professional reviews the report and interprets the results.

Duration

The procedure involves the patient wearing the recording device continuously for a period ranging from 48 hours to 21 days.

Setting

• Usually performed in outpatient clinics or cardiology offices.
• Initial setup and final data retrieval visits are required.

Personnel

• Cardiology technologist or nurse for device setup and removal.
• Cardiologist or trained healthcare provider for data analysis and interpretation.

Risks and Complications

• Skin irritation from electrode adhesive.
• Discomfort from wearing the device over an extended period.
• Rarely, incorrect data recording due to device malfunction or improper electrode placement.

Benefits

• Accurate diagnosis of intermittent heart rhythm abnormalities.
• Non-invasive and allows for normal daily activities.
• Helps in tailoring specific treatments based on detailed heart rhythm data.

Recovery

• No significant recovery period.
• Patients can resume normal activities immediately after the device is removed.
• Follow-up appointment to discuss results and any necessary treatment adjustments.

Alternatives

• Standard 24-hour Holter monitoring: Shorter duration; may miss less frequent arrhythmias.
• Event monitors: Worn for a longer period but only record when manually activated by the patient or when an abnormal rhythm is detected.

Patient Experience

• May feel conscious of the device but can typically do most normal activities.
• Mild skin irritation or discomfort where electrodes are placed.
• Generally, no pain involved, with minimal disruption to daily life.
• Instructions provided for managing discomfort and ensuring accurate recording.