Types of external ambulatory electrocardiogram monitoring

Holter monitoring recording

Record and document continuous 3-12- lead ECG during normal daily activities

Symptoms frequent enough to be detected within a period of 24-72h of monitoring

Event recorders

Record only selected ECG segments of fixed duration after an event is activated by the patient when
symptoms occur

Document arrhythmias that occur sporadically .

Limited use in patient with incapacitating symptoms.

External loop recorders

Record single-lead or up to 3-lead ECG segments of fixed duration marked as events either automatically
of activated by the patient.

Require patients to wear electrodes continuously during the recording period

Useful in patients with symptoms likely to recur within 2-4 weeks.

Patch ECG monitors

No lead or wires and adhesive to chest wall/sternum ; record a limited ECG FROM CLOSELY SPACED
ELECTRODES.

Long-term recording of 14 days or longer

Patient-activated or auto-triggered to provide a recording of events antecedent to , during , and after

the triggered event

Useful to detect arrhythmia that occurs every few weeks.

Smartphone applications

Commercially available smartphone-based systems

Can record a rhythm strip when the patient has symptoms , depending on the technology

Commercially-available smartwatch- based systems

Can record a rhythm strip when the patient has symptoms

Ambulatory telemetry monitoring

Provide continuous ECG recording or 24-h loop memory with wireless transmission ( real-time)to service
centre ( usually physicians are notified by technician if an arrhythmia is detected)

Useful when immediate streaming of an arrhythmic event or handling by a dedicated service centre is
warranted
General recommendation on the perioperative management of patients with cardiovascular implantable
electronic devices

Minimize the use of ipsilateral central lines , insert and remove pulmonary artery catheters under
fluoroscopic guidance, and take every measure to prevent bacteraemia if possible.

Inform the patient on the potential risk of electromagnetic interference during the procedure , and take
measure aimed to prevent it in accordance with the patient’s need and preferences.

Check the device before surgery if not done electively in the preceding 12 months or if battery longevity
is unknown .

Verify before surgery that the magnet mode is asynchronous pacing ( in many models , magnet mode is
programmable)

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The presence of pacemaker personnel in the building is necessary only in case when device
reprogramming is necessary or in procedures likely to cause strong electromagnetic interference.

Magnets should be easily available in all operating rooms when procedures are done in cardiovascular
implantable electronic device carries.

Monitor saturation waves if cautery impedes monitoring of the electrocardiogram.

Check the device after surgery if malfunction is suspected or if the devise has been exposed to
significant electromagnetic interference .