ECGmonitoring

ECG monitoring refers to the continuous or scheduled recording of the heart’s electrical activity through surface electrodes or implanted devices. It is used to detect arrhythmias, ischemia, conduction abnormalities, and to assess the effect of medications or devices on cardiac rhythm. Monitoring can be conducted in hospital, at home, or during activities, depending on device type and clinical question.

In hospital settings, telemetry systems wire a patient to a monitor that provides a real-time ECG trace with alarms for abnormal rhythms. Ambulatory monitoring includes Holter monitors (typically 24 to 48 hours of continuous recording), external patch monitors (often 7 to 14 days), and event monitors that record when symptoms occur or are triggered by the patient or automatically by software. Implantable loop recorders offer long-term monitoring for months to years and can detect infrequent events that other devices miss.

Interpretation focuses on rhythm, heart rate, intervals, and ST segments. Clinicians look for atrial fibrillation or flutter, ventricular arrhythmias, heart blocks, and ischemic changes, as well as other conduction disturbances. Data may be reviewed with waveform analysis software and by clinicians, with symptom correlation enhancing diagnostic yield. Artifacts from movement, poor electrode contact, or electrical interference can limit accuracy.

Indications include syncope or presyncope, palpitations, episodes of suspected arrhythmia, perioperative rhythm monitoring, and assessment during antiarrhythmic therapy. Limitations include incomplete event capture, movement artifacts, and the need for patient cooperation with device use. Privacy and data security are considerations for downloaded waveform data.