by Anthony Pearson, MD September 22, 2019
The Skeptical Cardiologist still feels that KardiaPro has eliminated use of long-term monitoring devices for most of his atrial fibrillation (afib) patients.
However, not all my afib patients are willing and able to self-monitor their condition using the AliveCor Mobile ECG device. For the Kardia-unwilling and the many patients who don't have known afib, we are still utilizing lots of long-term monitors.
The ambulatory ECG monitoring world is very confusing and ever-changing, but I recently came across a nice review of the field in the Cleveland Clinic Journal of Medicine that can be read in its entirety for free here.
This table, based off of the CCJM review, summarizes the various options available. I particularly like that they included relative cost.
The traditional ambulatory ECG device is the "Holter" monitor which is named after its inventor and is relatively inexpensive and worn for 24 to 48 hours.
The variety of available devices are depicted in this nice graphic from CCJM:
For the last few years, we have predominantly been using the 2-week "patch" type devices for most of our patients who warrant a long-term monitor. The Zio is the prototype for this, but we are also increasingly using the BioTelemetry patch.
The more expensive mobile cardiac outpatient telemetry devices like the one below from BioTel look a lot like the patches now. The major difference to the patient is that the monitor has to be taken out and recharged every 5 days. In addition, BioTel techs are reviewing the signal from the device so they can notify the patient if the ECG from the patch is inadequate and have them switch to an included lanyard/electrode set-up.
The advantage of the patch monitors is that they are ultraportable, relatively unobtrusive, and they monitor continuously with full disclosure.
The patch is applied to the left chest and usually stays there for 2 weeks (and yes, patients do get to shower during that time), after which time it is mailed back to the company for analysis.
Please also note that I have no financial or consulting ties to AliveCor or any other products or companies noted here.
Anthony Pearson, MD, is a private practice noninvasive cardiologist and medical director of echocardiography at St. Luke's Hospital in St. Louis. He blogs on nutrition, cardiac testing, quackery, and other things worthy of skepticism at The Skeptical Cardiologist, where a version of this post first appeared.
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