Cardiovascular Monitors/EP

what are some cardiac monitors?

-holter monitor

-patch recorder

-loop/event recorder

-electrophysiology study

what is a holter monitor?

continuous recording of cardiac electrical activity for 24-48 hrs (pt keeps a diary to mark events)

how do holter monitors work?

pt pushes a button anytime they develop sxs and person analyzing ECG can trace the exact moment to see if caused by an arrythmia

what are indications for holter monitor?

-syncope

-palpitations

-unexplained dyspnea

-atypical chest pain

-hypotension

-assess pacemaker function

-monitor antiarrhythmic meds

how are holter monitors intrepreted?

ECG is recorded to electronic filers (computer will highlight anomalies) & cardiologist interprets the highlighted areas

what are advantages of a holter monitor?

-records and stores all data (no need to transmit data)

-less annoyance/noninvasive

-correlates sxs w/ arrythmia

what are disadvantages of a holter monitor?

-infrequent symptoms (brief duration of recording)

-no real-time data transmission

-discomfort

-electrode dysfx

-noncompliance

-interference from electronics

what is a patch recorder?

records continuously for 14 days w/ no limitations on daily activities and identifies more arrhythmias

when are event recorders indicated?

-palpitations

-syncope/pre-syncopal sxs

-a fib

what are examples of event recorders?

-external loop recorder

-implantable loop recorder

-post-event/symptom recorder

-mobile cardiac outpatient telemetry

what is a loop recorder (event recorder)?

longer duration but only saves certain tracings

how long are loop recorders used external vs internal?

up to 30 days; up to 3 years

what is a symptom recorder (event recorder)?

post-event recorder with no sticker electrodes, records rhythm after becoming symptomatic

how are event recorders interpreted?

ECG tracings only during marked events, data is transmitted by phone or computer

what are advantages of event recorders?

correlates sxs w/ arrhythmia & longer time for data collection

what are advantages of internal event recorders?

good for noncompliant pts & longer time period

what are disadvantages of event recorders?

doesn't record short arrhythmias & only records certain date

what are disadvantages of internal event recorders?

expensive, invasive, limited data storage

what are mobile cardiac outpatient telemetry event recorders (MCOT)?

blended benefits of holter, patch, & ELR - 3x as likely to identify significant arrythmia vs ELR

what is an electrophysiologic (EP) study?

studies evoke potentials within cardiac tissue, identifying locations of conduction abnormalities or origins of arrhythmia

what are indications for an EP study?

-arrhythmias: SVT, torsades de pointes, PVCs, a fib/flutter

-sinus node dysfx

-conduction abnormalities: AV block, bundle branch block, syncopal episodes/palpitations, WPW

what is the procedure for an EP study?

femoral vein approach w/ fluoroscopy, electrodes are placed as shown to deliver energy and pace the heart

what is ablation therapy?

hot or cold energy used to burn source of arrhythmia, uses EP catheter