Ambulatory_ECG_Monitoring_Presentation (1).pptx

medicine

1. Mohd Halmi Bin Laili Farid Nor Izzat Bin Muhammad Zamri Surein A/L Chandran Ambulatory ECG Monitoring

2. Introduction Definition Continuous ECG recording during daily activities Ambulatory ECG monitoring serves to document the cardiac rhythm during an episode of palpitations if this cannot be done by means of standard ECG, as in the case of short-lasting symptoms. utilizes electrocardiographic recorders that are able to monitor the patient's cardiac Rhythm for long periods of time or that can be activated by the patient when symptoms occur. Purpose Detect intermittent arrhythmias not seen on standard ECG Duration 24 hours to 2 weeks depending on device type

3. Types of Ambulatory ECG Monitoring The types fo device that currently on use can be subdivided into 2 types External Devices: Holter Monitor ( 24–48 hours continuous recording ) Event loope Recorders ( patient-activated during symptoms ) Patch Monitors ( adhesive patches, up to 14 days ) Mobile Cardiac Telemetry (MCT) ( continuous, real-time monitoring ) Telemetry monitor (real-time, reviewable ( critical care wards) Implantable Devices : P acemakers ICDs diagnostic features (used exclusively in patients requiring such devices for therapeutic purposes) implantable loop recorders (ILRs).

4. The specificity of ambulatory ECG monitoring, at least in formulating a diagnosis of arrhythmic palpitations or non-arrhythmic palpitations, is optimal, whereas the sensitivity is extremely variable and depends on the following factors: the monitoring techniques used, the duration of monitoring, patient compliance, and, most importantly, the frequency of the attacks. In patients with palpitations of unknown origin, Holter monitoring has displayed a rather low sensitivity value . In patients in whom the symptoms are quite frequent (i.e. daily or weekly), external loop recorders and event recorders have shown both a higher diagnostic value (66–83%) and a better cost/effectiveness ratio than Holter devices. In patients with symptoms of possible arrhythmic origin, mobile cardiac outpatient telemetry has been seen to exhibit a higher diagnostic value than the other external devices.

5. Holter monitoring The Holter monitor is a type of continuous ECG used to monitor the ECG tracing continuously for a period of 24 hours or longer. ln addition to monitoring the ECG, symptoms should be recorded in a diary to aid the task of diagnosing their cause. Patients with symptoms occurring daily or almost daily, should be ideally evaluated with Holter monitoring

6. consists of two basic parts; Hardware (called monitor or recorder) for recording the signal. Software for review and analysis of the record. COMPONENTS OF HOLTER SYSTEM

7. Before placing the Memory Card with the stored settings in the recorder, you have to prepare the recorder: provide the recorder with a fresh set of batteries. attach the patient cable. check if the recorder displays the correct time and date. pre use check on holter monitoring system

8. Procedural Method 3 Lead 5 lead

9. Inform doctor of any significant abnormal findings that warrant immediate action. File strip / save in computerized system Dispatch / refer back for further follow up to relevant doctor Return of device and data analysis Generate automation computerized report view ECG graph, edit data and final print-out of report (patient's particulars, rhythm summary, hourly summary, interpretation, ST / heart rate trend, arrhythmia trend, filed strips) Procedural Method

10. Indications Palpitations for investigation S yncope for investigation P resyncope for investigation Suspected arrhythmias not captured on standard ECG Risk stratification post-MI or in heart failure Monitoring response to antiarrhythmic therapy Assess pacemaker or ICD function

11. Contraindications Severe skin allergy/infection at electrode site Patients unable to comply with instructions Limited usefulness in very infrequent symptoms (unless long-term patch/MCT is used)

12. factors that may interfere the holter monitoring results The attachment of the electrodes to the patient body. The electromagnetic disturbance - noisy record. Patient moves rapidly, the distortion will be even bigger. Muscle tremors. Sampling rate and resolution of the digitized signal (high quality devices offer higher sampling frequency).

13. Future Advancements Wearable smart devices (smartwatches, patches) AI-based arrhythmia detection Integration with telemedicine platforms Cloud-based data analytics for early diagnosis

14. Summary Ambulatory ECG is essential for detecting intermittent arrhythmias Choice of device depends on clinical scenario Technological advancements improve accuracy and patient comfort

15. References Al-Khatib, S. M., Stevenson, W. G., Ackerman, M. J., et al. (2018). 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias. Circulation, 138(13), e272–e391. American Heart Association. (2024). Ambulatory ECG Monitoring. https://www.heart.org Zimetbaum , P., & Goldman, A. (2021). Ambulatory arrhythmia monitoring: Choosing the right device. New England Journal of Medicine, 384(4), 368–378.