30 minute Short Holter Monitoring in Outpatient Practices - New Clues to Diagnosis

Abstract

Cardiac monitoring devices have multiplied in the last few years, and have become instantly accessible hence leading to newer indications. 50 and more years ago, it was only used for critically ill patients, for an arrhythmia watch. The present day compact form factor, coupled with a real time online data display has now expanded indications to include identification of arrhythmias, ischaemia and QT intervals in drug trials. The current trend has been to enable longer and longer monitoring periods thus reducing the chance of missing significant arrhythmias. The cost of this is an increased waiting time for deployment and for analysis. Yet a significant number of arrhythmias may be identified with short monitoring periods of even a few minutes [1]. We present our experience with Sydäntek, from Carditek Medical Device, in office cardiology as a short term monitor. The study was undertaken in all diabetic, hypertensive and post stroke patients attending a routine cardiology clinic. Results showed unexpected bradycardia, atrial fibrillation, ventricular ectopics, ventricular tachycardia and pauses, leading to modification of medications and doses. This would have been missed with a routine 6 sec ECG which is the norm in the clinic . The report from this device is immediate with automation, analytics for 8 clinically significant arrhythmias, algorithms to detect non-usable, noisy segments, max and minimum heart rate, respiratory patterns and heart rate variability. We present the clinical implications and technical details for the automation . We propose that even short term, 30 min ECG monitoring has a role in effective and improved management of the patients.