Name of the Procedure:

External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; scanning analysis with report. Commonly known as Extended Holter Monitoring.

Summary

Extended Holter Monitoring involves wearing an electrocardiographic (ECG) device continuously for 7 to 15 days to record the heart's electrical activity. The data is then analyzed, and a report is generated to help diagnose heart rhythm abnormalities.

Purpose

The main goal of extended Holter monitoring is to identify irregular heart rhythms (arrhythmias) that may not be detected in shorter duration recordings. It is used to diagnose the cause of symptoms like palpitations, dizziness, or fainting.

Indications

• Symptoms such as heart palpitations, dizziness, or fainting.
• Unexplained chest pain.
• History of irregular heartbeats (arrhythmias).
• Evaluation of heart conditions that may lead to stroke.
• Monitoring the effectiveness of treatment for known heart conditions.

Preparation

• Wear comfortable clothing; you may need to adjust your wardrobe to accommodate the device.
• Continue taking medications as prescribed unless directed otherwise by your physician.
• A preliminary ECG or other baseline heart tests may be done.

Procedure Description

1. The healthcare provider will attach several electrodes to the patient's chest.
2. These electrodes are connected to a small portable ECG device that the patient wears around the waist or over the shoulder.
3. The patient will continue with daily activities while the device records the heart's electrical activity 24/7.
4. After the recording period (7 to 15 days), the device is returned to the healthcare provider.
5. The data is then scanned and analyzed by a cardiologist, who generates a report based on the findings.

Duration

The monitoring period lasts from 7 to 15 days. The actual device attachment and removal take about 30-45 minutes each time.

Setting

This procedure is typically performed on an outpatient basis, either at a hospital, outpatient clinic, or the patient's home.

Personnel

• Trained technician or nurse to set up and remove the device.
• Cardiologist to interpret the data and write a report.

Risks and Complications

• Mild skin irritation or rash where electrodes are attached.
• Discomfort wearing the device for an extended period.
• Rarely, skin infection at the electrode sites.

Benefits

• Helps in diagnosing arrhythmias that could not be captured in shorter recordings.
• Provides a comprehensive analysis of heart rhythm over an extended period.
• Assists in tailoring effective treatment plans for heart conditions.

Recovery

• Minimal recovery is required as the procedure is non-invasive.
• The patient may resume normal activities immediately after the device is removed.
• Follow-up appointments may be scheduled to discuss the results.

Alternatives

• Short-term Holter Monitoring (24-48 hours).
• Event Monitor, which records only when the patient activates it during symptoms.
• Implantable Loop Recorder for continuous monitoring over months to years.
  • Pros: Alternatives may be less cumbersome for some patients.
  • Cons: They may not capture infrequent arrhythmias as effectively as extended monitoring.

Patient Experience

• Patients may initially feel self-conscious or discomfort wearing the device.
• Some may experience mild skin irritation where electrodes are placed.
• Regular activities should proceed as usual, but showers or baths may be restricted to protect the device.
• Pain is minimal, managed by adjusting electrode placement if needed. Comfort measures can include using hypoallergenic adhesives or repositioning the device.