event monitoring (event recording, loop recording, Zio patch)
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Introduction
Similar to HOLTER, but is worn for longer periods of time. Diagnostic yield of event recording is generally greater than that of HOLTER monitoring.
Indications
- infrequent symptomatic brief arrhythmias
- recurrent syncope
- an implantable loop recorder is useful in identifying infrequent arrhythmias when previous 30-day monitoring is non diagnostic
Advantages
(not mentioned above)
- captures arrhythmia onset
Disadvantages
- ECG leads limit patient activity
Clinical significance
- definitive results (i.e. event with or without dysrhythmia is obtained about 30% of tests)
Procedure
- continuous electrocardiographic monitoring
- before or after symptoms, the patient may trigger the memory loop*
- when activated, the preceding 30-120 seconds of ECG activity are recorded; several minutes of post triggering may be recorded
- loop recording allows for weeks to months# of continuous surveillance
- devices are generally external
- implantable event recorders are placed subcutaneously under local anesthesia[1][2]
- capacity is 42 minutes
- battery life is 3 years
- a small pocket-size recorder that is held to the chest when symptoms are present is also available (see Notes)
- Ziopatch attaches to skin over heart, worn for 14 days provides continuous monitoring with rhythm analysis[3]
* The patient must trigger the device to capture the ECG tracing.
# Generally, devices are provided to patients for a 30 day period.
Interpretation
Results are limited by:
- frequency of syncopal episodes
- patient's failure to trigger recorder
Notes
- post-symptom event recorders, in contrast to looping recorders, begin rhythm recording after the device is triggered by the patient
- small, pocket-sized recorders held to the chest when symptoms are present
- not useful for evaluation of syncope since the patient awakens to activate the device when the symptoms have resolved
- it is the loop recording feature that allows event recording to capture event(s) within the two minutes prior to patient-initiated device activation
- mobile cardiac outpatient telemetry systems are used in some centers[1]
More general terms
More specific terms
Additional terms
References
- ↑ 1.0 1.1 1.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015
- ↑ 2.0 2.1 Parry SW, Matthews IG. implantable loop recorders in the investigation of unexplained syncope: a state of the art review. Heart. 2010 Oct;96(20):1611-6 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20937748
- ↑ 3.0 3.1 Zio by iRhythm Precision in Practice https://www.irhythmtech.com/precision-in-practice