Advantages, limitations, and indications of the different ambulatory electrocardiogram monitoring devices
| . | Holter monitoring . | Event recorders . | External loop recorders/MCOT . | Implantable loop recorders . | Pacemakers/ICDs . |
|---|---|---|---|---|---|
| Advantages | Low cost; possibility to record asymptomatic arrhythmias | Low cost; easy to use | Retrospective and prospective ECG records; possibility to record asymptomatic arrhythmias automatically | Retrospective and prospective ECG records; quite good ECG records; monitoring capability up to 36 months; possibility to record asymptomatic arrhythmias automatically | Better discrimination between ventricular and supraventricular arrhythmias, due to dual chamber IEGM recordings; better definition of arrhythmic burden; monitoring duration for many years (corresponding to the expected life of the device); possibility to record asymptomatic arrhythmias automatically |
| Limitations | Monitoring limited to 24 h to 7 days; size may prevent activities that may trigger the arrhythmias; patients often fail to complete adequately the clinical diary upon which the correlation between symptoms and the arrhythmias recorded is based | Monitoring cannot be carried out for more than 3–4 weeks; very brief arrhythmias are not recorded; arrhythmic triggers are not revealed; poor ECG records | Monitoring cannot be carried out for more than 3–4 weeks; continual maintenance is required; devices are uncomfortable; quite poor ECG records | Invasiveness; risk of local complications at the implantation site: higher cost; limited memory and specificity | Invasiveness; risk of early and late local and systemic complications; high costs |
| Indications | From daily to weekly palpitations; patients who are unable to use other ambulatory ECG monitoring devices | From weekly to monthly, fairly long-lasting palpitations not accompanied by haemodynamic impairment; compliant patients | From weekly to monthly, short-lasting palpitations associated to haemodynamic impairment; very compliant patients | From monthly to yearly palpitations associated with haemodynamic compromise; when all the other examinations prove inconclusive; non-compliant patients without haemodynamic compromise when a clinically significant arrhythmic cause is likely or must be ruled out | Only for patients with conventional indications to pacemakers and ICDs |
| . | Holter monitoring . | Event recorders . | External loop recorders/MCOT . | Implantable loop recorders . | Pacemakers/ICDs . |
|---|---|---|---|---|---|
| Advantages | Low cost; possibility to record asymptomatic arrhythmias | Low cost; easy to use | Retrospective and prospective ECG records; possibility to record asymptomatic arrhythmias automatically | Retrospective and prospective ECG records; quite good ECG records; monitoring capability up to 36 months; possibility to record asymptomatic arrhythmias automatically | Better discrimination between ventricular and supraventricular arrhythmias, due to dual chamber IEGM recordings; better definition of arrhythmic burden; monitoring duration for many years (corresponding to the expected life of the device); possibility to record asymptomatic arrhythmias automatically |
| Limitations | Monitoring limited to 24 h to 7 days; size may prevent activities that may trigger the arrhythmias; patients often fail to complete adequately the clinical diary upon which the correlation between symptoms and the arrhythmias recorded is based | Monitoring cannot be carried out for more than 3–4 weeks; very brief arrhythmias are not recorded; arrhythmic triggers are not revealed; poor ECG records | Monitoring cannot be carried out for more than 3–4 weeks; continual maintenance is required; devices are uncomfortable; quite poor ECG records | Invasiveness; risk of local complications at the implantation site: higher cost; limited memory and specificity | Invasiveness; risk of early and late local and systemic complications; high costs |
| Indications | From daily to weekly palpitations; patients who are unable to use other ambulatory ECG monitoring devices | From weekly to monthly, fairly long-lasting palpitations not accompanied by haemodynamic impairment; compliant patients | From weekly to monthly, short-lasting palpitations associated to haemodynamic impairment; very compliant patients | From monthly to yearly palpitations associated with haemodynamic compromise; when all the other examinations prove inconclusive; non-compliant patients without haemodynamic compromise when a clinically significant arrhythmic cause is likely or must be ruled out | Only for patients with conventional indications to pacemakers and ICDs |
IEGM, intracardiac electrogram; MCOT, mobile cardiac outpatient telemetry.
Advantages, limitations, and indications of the different ambulatory electrocardiogram monitoring devices
| . | Holter monitoring . | Event recorders . | External loop recorders/MCOT . | Implantable loop recorders . | Pacemakers/ICDs . |
|---|---|---|---|---|---|
| Advantages | Low cost; possibility to record asymptomatic arrhythmias | Low cost; easy to use | Retrospective and prospective ECG records; possibility to record asymptomatic arrhythmias automatically | Retrospective and prospective ECG records; quite good ECG records; monitoring capability up to 36 months; possibility to record asymptomatic arrhythmias automatically | Better discrimination between ventricular and supraventricular arrhythmias, due to dual chamber IEGM recordings; better definition of arrhythmic burden; monitoring duration for many years (corresponding to the expected life of the device); possibility to record asymptomatic arrhythmias automatically |
| Limitations | Monitoring limited to 24 h to 7 days; size may prevent activities that may trigger the arrhythmias; patients often fail to complete adequately the clinical diary upon which the correlation between symptoms and the arrhythmias recorded is based | Monitoring cannot be carried out for more than 3–4 weeks; very brief arrhythmias are not recorded; arrhythmic triggers are not revealed; poor ECG records | Monitoring cannot be carried out for more than 3–4 weeks; continual maintenance is required; devices are uncomfortable; quite poor ECG records | Invasiveness; risk of local complications at the implantation site: higher cost; limited memory and specificity | Invasiveness; risk of early and late local and systemic complications; high costs |
| Indications | From daily to weekly palpitations; patients who are unable to use other ambulatory ECG monitoring devices | From weekly to monthly, fairly long-lasting palpitations not accompanied by haemodynamic impairment; compliant patients | From weekly to monthly, short-lasting palpitations associated to haemodynamic impairment; very compliant patients | From monthly to yearly palpitations associated with haemodynamic compromise; when all the other examinations prove inconclusive; non-compliant patients without haemodynamic compromise when a clinically significant arrhythmic cause is likely or must be ruled out | Only for patients with conventional indications to pacemakers and ICDs |
| . | Holter monitoring . | Event recorders . | External loop recorders/MCOT . | Implantable loop recorders . | Pacemakers/ICDs . |
|---|---|---|---|---|---|
| Advantages | Low cost; possibility to record asymptomatic arrhythmias | Low cost; easy to use | Retrospective and prospective ECG records; possibility to record asymptomatic arrhythmias automatically | Retrospective and prospective ECG records; quite good ECG records; monitoring capability up to 36 months; possibility to record asymptomatic arrhythmias automatically | Better discrimination between ventricular and supraventricular arrhythmias, due to dual chamber IEGM recordings; better definition of arrhythmic burden; monitoring duration for many years (corresponding to the expected life of the device); possibility to record asymptomatic arrhythmias automatically |
| Limitations | Monitoring limited to 24 h to 7 days; size may prevent activities that may trigger the arrhythmias; patients often fail to complete adequately the clinical diary upon which the correlation between symptoms and the arrhythmias recorded is based | Monitoring cannot be carried out for more than 3–4 weeks; very brief arrhythmias are not recorded; arrhythmic triggers are not revealed; poor ECG records | Monitoring cannot be carried out for more than 3–4 weeks; continual maintenance is required; devices are uncomfortable; quite poor ECG records | Invasiveness; risk of local complications at the implantation site: higher cost; limited memory and specificity | Invasiveness; risk of early and late local and systemic complications; high costs |
| Indications | From daily to weekly palpitations; patients who are unable to use other ambulatory ECG monitoring devices | From weekly to monthly, fairly long-lasting palpitations not accompanied by haemodynamic impairment; compliant patients | From weekly to monthly, short-lasting palpitations associated to haemodynamic impairment; very compliant patients | From monthly to yearly palpitations associated with haemodynamic compromise; when all the other examinations prove inconclusive; non-compliant patients without haemodynamic compromise when a clinically significant arrhythmic cause is likely or must be ruled out | Only for patients with conventional indications to pacemakers and ICDs |
IEGM, intracardiac electrogram; MCOT, mobile cardiac outpatient telemetry.
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