External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; recording (includes connection and initial recording)
CPT4 code
Name of the Procedure:
External Electrocardiographic Recording for More Than 48 Hours Up to 7 Days by Continuous Rhythm Recording and Storage; Recording (Includes Connection and Initial Recording)
Common Names:
- Extended Holter Monitoring
- 7-Day Holter Monitor
- Ambulatory ECG
Summary
Extended Holter Monitoring involves wearing a small device that continuously records the heart's electrical activity over a period of more than 48 hours, up to 7 days. This provides detailed data about the heart's rhythm and can help identify issues that may not show up during a regular ECG.
Purpose
The primary purpose of this procedure is to diagnose irregular heart rhythms (arrhythmias) and other cardiac issues that might not be detectable during a standard ECG. It helps to monitor ongoing symptoms and evaluate the effectiveness of treatments.
Indications
- Unexplained fainting (syncope)
- Palpitations or irregular heartbeats
- Diagnosis of arrhythmias
- Monitoring effectiveness of heart medications
- Evaluation before and after cardiac treatments
Preparation
- Wear comfortable clothing with easy access to the chest area.
- Avoid using lotions or oils on the chest area.
- Continue taking prescribed medications unless instructed otherwise by your healthcare provider.
- No fasting or special dietary preparations are usually required.
Procedure Description
- Connection: Electrodes are attached to your chest using adhesive patches. These electrodes are connected to a lightweight, portable recording device.
- Initial Recording: The device is activated to begin recording your heart's activity.
- Continuous Monitoring: You will wear the device for the designated period (48 hours up to 7 days).
- Activity Log: You may be asked to keep a diary to log activities, symptoms, and any irregular sensations you feel.
Tools and Equipment
- Electrodes
- Portable ECG recorder
Anesthesia or Sedation
- None required
Duration
The connection and initial recording setup typically take about 20-30 minutes. The monitoring duration is from 48 hours up to 7 days, depending on your doctor’s recommendation.
Setting
This procedure is typically performed in an outpatient setting such as a clinic or doctor's office.
Personnel
- Trained medical assistant or nurse for device setup
- Cardiologist or specialized physician for data analysis
Risks and Complications
- Common: Skin irritation at electrode sites
- Rare: Allergic reaction to adhesive, discomfort due to wearing the device
Benefits
- Provides comprehensive data on heart activity over an extended period
- Can identify intermittent arrhythmias not detected in a standard ECG
- Non-invasive and easy to wear
Recovery
- Post-Procedure Care: None required. Return the device as instructed for data analysis.
- Recovery Time: Immediate return to normal activities once the device is removed.
- Restrictions: Limited exposure to moisture and avoiding strenuous activities that might dislodge electrodes.
Alternatives
- Standard Electrocardiogram (ECG): Shorter duration, but may miss intermittent issues.
- Event Monitor: Worn for up to 30 days, activated by the patient during symptoms.
- Implantable Loop Recorder: Offers long-term monitoring but is invasive.
Pros and Cons of Alternatives:
- Standard ECG: Less detailed, shorter timeframe.
- Event Monitor: Longer duration, only records during symptoms.
- Implantable Loop Recorder: Long-term monitoring, but requires minor surgery.
Patient Experience
- During the Procedure: Mild discomfort from wearing the device. You may feel some skin irritation from the electrodes.
- After the Procedure: Freedom from the device, possible minor skin irritation.
- Pain Management: Typically none required. Over-the-counter remedies for skin irritation, if needed.