The Use of Mobile Cardiac Telemetry to Improve Diagnostic Accuracy and Enable More Efficient Patient Care

US Cardiology, 2012;9(1):43-46

Abstract

Mobile cardiac telemetry (MCT) is a relatively new technology, first approved in 2002 by the US Food and Drug Administration (FDA), which provides continuous realtime outpatient electrocardiographic monitoring for extended periods of time. MCT allows detection of both symptomatic and asymptomatic arrhythmias and has been proven to provide superior diagnostic capability for patients with palpitations, syncope, and pre-syncope. It also allows accurate monitoring of a patient’s rhythm during outpatient drug titration, as well as detection of both symptomatic and asymptomatic atrial fibrillation after cardiac ablation. Since recording of the rhythm is continuous, monitoring of a patient’s heart rate (as well as specific documentation of the initiation and termination of arrhythmias) is possible. This article will focus on how the use of MCT can improve diagnostic accuracy and, when combined with the use of a monitoring service that integrates the patient’s tracings within an electronic medical record, can also improve the efficiency of care given to patients.

Support: The publication of this article was funded by eCardio. The views and opinions expressed are those of the authors and not necessarily those of eCardio.

Keywords
Mobile cardiac telemetry, arrhythmias, palpitations, syncope, pre-syncope, atrial fibrillation, outpatient cardiac monitoring
Disclosure Steven Zweibel, MD, FACC, FHRS, has no conflicts of interest to declare. Melissa Trelfa, MA, is a Strategic Account Manager for eCardio.
Received: December 12, 2011 | Accepted February 06, 2012 | Citation US Cardiology, 2012;9(1):43-46
Correspondence: Steven Zweibel, MD, FACC, FHRS, Director, Electrophysiology, Hartford Hospital and Assistant Professor of Medicine, University of Connecticut School of Medicine, 80 Seymour Street, Hartford, CT 06102. E: szweibel@harthosp.org

Continuous outpatient monitoring of a patient’s heart rhythm was initiated in 1949 with the invention of the Holter monitor by Norman J Holter. The early systems were bulky, recorded the heart’s rhythm for 24 or 48 hours onto a tape or cassette, and required that the data be analyzed by a technician after completion of the recording. As technology advanced, smaller devices (event recorders) were developed to allow patients to record their rhythms when they had symptoms. These could be used for longer periods of time, but were limited in that the patient had to place the monitor onto his or her skin to make a recording, so brief episodes of palpitations or episodes of syncope could not be captured. Patient-activated loop recorders (LOOPs), devices which continually record a patient’s rhythm via electrodes attached to the skin, were able to capture brief episodes of palpitations or episodes of syncope, but depended on the patient to activate them and could not detect asymptomatic episodes of arrhythmia. Mobile cardiac telemetry (MCT) is a relatively new technology, first approved in 2002 by the US Food and Drug Administration (FDA), which provides continuous realtime outpatient electrocardiographic monitoring for extended periods of time. MCT allows detection of both symptomatic and asymptomatic arrhythmias and has been proven to provide superior diagnostic capability for patients with palpitations, syncope, and pre-syncope.1–3 It also allows accurate monitoring of a patient’s rhythm during outpatient drug titration, as well as detection of both symptomatic and asymptomatic atrial fibrillation (AF) after cardiac ablation. Since recording of the rhythm is continuous, monitoring of a patient’s heart rate (as well as specific documentation of the initiation and termination of arrhythmias) is possible. This article will focus on how the use of MCT can improve diagnostic accuracy and, when combined with the use of a monitoring service that integrates the patient’s tracings within an electronic medical record (EMR), can also improve the efficiency of care given to patients.

Case Report

The patient, a 56-year-old male, had a history of palpitations with documented runs of both supraventricular tachycardia (SVT) and AF. He was started on flecainide (a class Ic antiarrhythmic drug) for control of his arrhythmias and discharged home with an MCT device. The patient’s monitor triggered for SVT at a rate of 162 bpm at 4:50 am while he was doing his morning aerobic workout (see Figure 1).

References:
  1. Rothman SA, Laughlin JC, Seltzer J, et al., The Diagnosis of Cardiac Arrhythmias: A Prospective Multi-Center Randomized Study Comparing Mobile Cardiac Outpatient Telemetry Versus Standard Loop Event Monitoring, J Cardiovasc Electrophysiol, 2007;18:1–7.
  2. Tayal AH, Tian M, Kelly KM, et al., Atrial fibrillation detected by mobile cardiac outpatient telemetry in cryptogenic TIA or stroke, Neurology, 2008;71:1696–1701.
  3. Olson JA, Fouts AM, Padanilam BJ, Prystowsky EN, Utility of Mobile Cardiac Outpatient Telemetry for the Diagnosis of Palpitations, Presyncope, Syncope, and the Assessment of Therapy Efficacy, J Cardiovasc Electrophysiol, 2007;18:473–7.
  4. Fogel RI, Evans JJ, Prystowsky EN, Utility and cost of event recorders in the diagnosis of palpitations, presyncope, and syncope, Am J Cardiol, 1997;79:207–8.
  5. Bontempo LJ, Goralnick E, Atrial fibrillation, Emerg Med Clin North Am, 2011;29(4):747–58.
Keywords: Mobile Cardiac Outpatient Telemetry, Telemetry monitoring, Ambulatory cardiac monitor(ing), Advanced heart monitor(ing), Diagnostic heart monitor(ing), Pacemaker (s), arrhythmia monitoring, mobile cardiac telemetry, cardiac event monitors, Mobile cardiac telemetry, arrhythmias, palpitations, syncope, pre-syncope, atrial fibrillation, outpatient car

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