Role of AECG Monitoring for Atrial Fibrillation (A Fib)
Atrial Fibrillation (A-Fib) is a complex rhythm that is proven to significantly increase risk for adverse events including heart attack & stroke. Atrial Fibrillation is affects an estimated 2.7 million American each year with nearly 700,000 new cases detected each year. Atrial Fibrillation is a key consideration for effective medical management to lower the risk of a heart attack or stroke. With such a strong correlation between A Fib and adverse events, the medical community is seeking to improve methods to detect A Fib early on to reduce patient risk. Ambulatory Cardiographic Monitoring (AECG) remains the most useful of tools for detecting Atrial Fibrillation.
Overview of AECG (Ambulatory Electrocardiographic) Monitoring
AECG monitoring is a broad term to include a variety of forms of monitoring patient ECG in the ambulatory environment. Although there is a large variety in the different types of AECG monitoring, the general idea is to detect abnormal cardiac rhythms (arrhythmias) whether the patient feels the abnormality or not. The most common use of AECG monitoring is to correlate various patient symptoms such as chest pain, shortness of breath, palpitations, and light headedness to the patient ECG rhythm. However, there is now evolving evidence that AECG monitoring can be administered in some cases to assess patient risk regardless of any known symptoms. Such instances include monitoring of patients with cryptogenic or unexplained stroke. AECG monitoring can a useful tool for detection of asymptomatic arrhythmias such as Atrial Fibrillation.
Holter Monitoring is always the first step in AECG monitoring. Holter monitoring is considered the gold standard for AECG monitoring as the study is a 24 hour continuous recording of all ECG information. The Holter monitor study is very useful as it is used to capture various arrhythmias and assist clinicians to make symptom to event correlation.
Long Term Continuous monitoring (14 day Holter monitor)
Long term continuous ECG monitoring is a new form of AECG monitoring where the monitor is worn for an extended period of time. Long term continuous ECG monitoring is similar to a Holter monitor except in a much longer duration. Due to advancements in technology, new cardiac monitoring devices can collect and store up to 14 days of continuous monitoring information. Futher, there are new monitors available that can worn in the form of a peel & stick patch to make the process much easier on the patient. Long term continuous ECG monitoring is proving to be a useful tool in detecting arrhythmias such as atrial fibrillation.
Cardiac Event Monitoring is a standard term used to describe cardiac monitoring over an extended period of time. Cardiac Event Monitoring (also referred to as event monitoring) is a small recording device that is designed to capture cardiac rhythm abnormalities. Event monitors are generally small in size and record only when a symptom or cardiac event occurs. Event monitors generally do not record continuous ECG data which is evolving to be a significant technological disadvantage compared to newer monitoring technologies such as mobile cardiac telemetry and long term continuous ECG monitoring.
Mobile cardiac telemetry (MCT) monitoring is the most advanced form of AECG monitoring today. Mobile cardiac telemetry monitors are devices that monitor the patient’s ECG in real time. MCT technology automatically detects and automatically transmits cardiac abnormalities via cellular telephone to an external diagnostic laboratory for analysis. Some mobile cardiac telemetry devices have the capability to record continuous ECG while performing analysis in real time. This advancement in cardiac monitoring technology is likely to be the future of AECG monitoring.
Implantable cardiac monitors (ICM) are the most uncommon form of AECG monitoring. Implantable cardiac monitors are used only in rare cases where arrhythmias are suspected but not capable of being captured using another external form of AECG monitoring. Such cases can include cryptnogenic stroke and asymptomatic atrial fibrillation.
Summary
Ambulatory cardiac (AECG) monitoring remains the most effective method of detecting atrial fibrillation. However, selecting the right form of AECG monitoring for detecting a fib is not always a simple task. Each form of AECG monitoring is useful but newer forms of AECG monitoring such as long term continuous ECG monitoring and mobile cardiac telemetry seem to have distinct technological advantages. Evolving evidence suggests that a longer monitoring duration as well as acquiring continuous ECG data has exponential benefits of detecting atrial fibrillation and other arrhythmias that may go undetected if asymptomatic in nature.
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