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Advantages of Prescribing a Loop Recorder

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The definition of arrhythmia is irregular heartbeats.   This term is quite vague and encompasses many different abnormalities that have irregular heartbeats.   Diagnosing a patient with a general term of an “arrhythmia” is akin to diagnosing a patient with a “heart condition”.   This general term provides little useful information for the patient or the physician.   The reason is there are many types of arrhythmias with varying symptoms and prognoses.

There are literally dozens of different types of arrhythmias.   Some arrhythmias are instantly life threatening while others are completely benign.   Some cause symptoms like a racing heartbeat or fainting spells while others may produce absolutely no symptoms whatsoever.   Therefore it is of paramount importance to make a specific diagnosis of the type of arrhythmia the patient has.

The key to diagnosing an arrhythmia is some form of electrocardiographic recording like an ECG, Holter monitor or loop event recorder, must be made when the arrhythmia is actually occurring.   Evaluation solely based on symptoms alone is inadequate, because symptoms from different arrhythmias can feel exactly the same to a patient.  It’s also possible for the same arrhythmia to feel differently among different patients.   For instance, the sensation of palpitation can occur in patients with ventricular tachycardia or isolated premature ventricular contractions, two conditions with vastly different prognoses.   The physician, therefore, usually can’t diagnose one arrhythmia from another based solely on symptoms.

In addition, what can make a diagnosis quite challenging is in between episodes of arrhythmias, the ECG can be completely normal.   For example, all too often a patient experiences an episode of supraventicular tachycardia (a very rapid arrhythmia) once a month, lasting 10 minutes each.   Each time this patient heads to the emergency room, the arrhythmia has already stopped and the ECG in the ER is totally normal.   These patients are usually misdiagnosed as having a panic attack or anxiety because of the lack of physical evidence (other than patient’s subjective report of symptoms) of an arrhythmia.   The true diagnosis can be quite elusive until the day when an ECG is finally done when an episode is still ongoing.

For persistent arrhythmias, the diagnosis is quite easy with a routine ECG done in the physician’s office.   The challenge is when an arrhythmia either occurs intermittently or is self-limiting, whereby a ECG performed in between attacks can be normal.  Long term monitors are used to circumvent this problem.

Long-term monitors are basically ECG recorders that patients take home.   A Holter monitor records continuous ECG, usually for 24 hours to 48 hours.   The advantage of a Holter monitor is that every single heartbeat is recorded and is analyzed.   The disadvantage is that if an arrhythmia did not occur on that particular day, the Holter data would not be useful.   Also, the technician that analyses the data has to analyze the full 24 – 48 hours of data and is not focusing on ECG when the patient experiences symptoms.   On the other hand, because a loop recorder is a long-term monitor that can be used for up to 30 days at a time it has several advantages over a Holter monitor.   It has a longer the recording period, so there is a better chance of catching a sporadic arrhythmia.  Further the technician is more efficient because they are able to focus on the symptomatic events.   Lastly, because the ECG recording occurs when triggered by the patient, the physician can determine whether patient’s symptoms are actually caused by an arrhythmia.

Braemar ER920 Loop Event Recorder

In summary, given a physician can’t diagnose an arrhythmia based on symptoms, an ECG monitor is required.   Deciding on what monitor to use should be based on the frequency of symptoms.   For symptoms that occur all the time an ECG is appropriate.   For symptoms that occur often, a Holter monitor is recommended.   For symptoms that occur infrequently, a loop recorder should be used.

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