Ambulatory Electrocardiography, Transient Event Monitors, and Continuous Loop Recorders

Abstract

Palpitations are sensations of an irregular or rapid heartbeat [1]. Although usually benign, palpitations may be related to dangerous cardiac arrhythmias or portend the likelihood of syncope or near-syncope [2]. If their etiology cannot be discerned from the clinical history, physical examination, or resting electrocardiogram, ambulatory electrocardiographic (AECG) monitoring is recommended [3, 4]. Various modalities exist and their selection depends upon the duration of monitoring likely to capture or record the electrocardiogram during symptoms, whether daily palpitations or sensations separated by days, weeks or even months. The gold standard for diagnosing an arrhythmia is obviously symptom–rhythm correlation. AECG monitoring permits monitoring synchronous with normal daily activity. A standard electrocardiogram is a focal record of 9–10 seconds of the heart’s rhythm and rate. The ECG is limited in its dynamic ability since it is a “snapshot” of the heart rhythm. The AECG provides a mechanism to effectively capture the presence and features of an arrhythmia (if one exists) simultaneous with symptoms. True arrhythmogenic symptoms should have corresponding electrocardiographic abnormalities.