Prescribed Ambulatory Cardiac Rhythm Monitors

EP: 1.Clinical Presentation of Arrhythmias

EP: 2.Long-Term Consequences of Arrhythmias

EP: 3.Common Comorbidities and Underdiagnosis Associated With Atrial Fibrillation

EP: 4.Unmet Needs in the Management of Atrial Fibrillation

EP: 5.Optimizing the Management of Atrial Fibrillation Through Team-Based Care

EP: 6.Best Practices for Diagnosing Arrhythmia

Now Viewing

EP: 7.Prescribed Ambulatory Cardiac Rhythm Monitors

EP: 8.Electronic Health Records and Consumer Wearables

There are various types of cardiac rhythm monitors, each with distinct advantages and limitations related to cost, duration of monitoring, patient comfort, and diagnostic accuracy. Common options include short-term Holter monitors, event monitors lasting up to 30 days, wearable patches, real-time mobile cardiac telemetry, and implantable loop recorders for long-term monitoring. Despite the availability of these technologies, clinical practice often follows a stepwise pattern—starting with a short-term monitor and escalating to more advanced options if needed. However, this approach may not always be the most efficient or patient-centered.

Selecting the appropriate monitor depends on several factors, including the frequency and severity of symptoms, the patient’s risk profile and comorbidities, and their ability to comply with device requirements such as triggering alerts. For example, patients with frequent symptoms may benefit from shorter monitoring periods with less expensive devices, while those at higher risk or with infrequent episodes may require more sophisticated, longer-term monitoring options. Additionally, there remains a gap in available technologies for continuous monitoring between 30 days and 1 year, highlighting the need for further innovation in this area.

From a cost-effectiveness and clinical perspective, decisions should be guided by the patient’s history and pretest probability. Different symptom patterns, such as syncope occurring in various positions or with different associated features, can indicate distinct underlying causes and influence the choice of monitoring. Overuse of implantable devices without clear indication can lead to increased costs and potential harm without improved outcomes. Therefore, personalized decisions that balance symptom burden, risk, cost, and patient experience are essential. Providing clinicians with clear guidance based on symptom frequency and risk can improve diagnostic accuracy, reduce unnecessary testing, and optimize resource utilization.