Ambulatory electrocardiography devices
| Device | Design | Duration | Indications | Advantages | Limitations | Cost |
|---|---|---|---|---|---|---|
| Holter monitor | 3–12 leads attached by wires Data are uploaded after recording is complete | 24–48 hours continuously | Palpitations, syncope, or presyncope when symptoms occur nearly daily Silent arrhythmia that occurs frequently or to assess for arrhythmia recurrence after therapy | Continuous recording Full disclosure Up to 12 leads Physician familiarity | Short duration Post hoc analysis Uses wires and gel electrodes | $ |
| Post-event recorder | Leadless held to the chest during symptoms Real-time transmission of data for analysis | Up to 30 days intermittently | Infrequent symptoms (eg, palpitations) that are not debilitating | Extended observation Real-time data transmission | Records only selected sequences Requires patient activation | $ |
| External loop recorder | 3–12 leads attached by wires Records when triggered by patient or arrhythmia | Up to 30 days; continuous observation and intermittent recording | Infrequent symptoms or suspected infrequent silent arrhythmia | Extended recording Automated arrhythmia analysis Multichannel acquisition Backwards memory | Records only selected sequences Uses wires and gel electrodes | $$ |
| Implantable loop recorder | Implanted subcutaneously in the left parasternal region | Up to 3 years; continuous observation and intermittent recording | Very infrequent symptoms Suspected paroxysmal atrial fibrillation in cryptogenic stroke | Very long observation Automated arrhythmia analysis | Records only selected sequences Requires surgical insertion High cost | $$$$ |
| Mobile cardiac telemetry | 3 leads attached by wires Communicates with portable monitor and real-time transmission for analysis | 1–4 weeks continuously | Suspected high-risk arrhythmia (eg, ventricular tachycardia) that can be identified and addressed in real time After starting new antiarrhythmic drug | Continuous and extended recording Real-time rhythm analysis and response | Requires significant manpower for monitoring High up-front cost for device | $$$ |
| Patch monitor | Affixed to the left pectoral region Some have real-time telemetry, others require later data analysis | 2–4 weeks continuously | Moderate frequency symptoms or suspected low-risk asymptomatic arrhythmia | Continuous recording Full disclosure Ergonomic design increases patient adherence | Single channel Needs post hoc analysis | $$ |
| Smart- tech ECG | Fingers are placed on an external sensor Generates a single- lead electrocardiogram on the phone or watch screen | 30 seconds intermittently | Intermittent, low-risk, nondebilitating symptoms (eg, palpitations in low-risk clinical context) | Widely available Automated rhythm analysis for atrial fibrillation | Single channel No continuous observation Requires patient activation | $ |
$ = < $150; $$ = $150–$500; $$$ = $500–$1,000; $$$$ = > $1,000