Introduction. Keywords: Ambulatory electrocardiography, cardiac arrhythmias, syncope

Size: px
Start display at page:

Download "Introduction. Keywords: Ambulatory electrocardiography, cardiac arrhythmias, syncope"

Transcription

1 Hong Kong Journal of Emergency Medicine The use of ambulatory electrocardiography in the emergency medicine ward to assess patients with symptoms possibly related to cardiac arrhythmia: a sharing of experience in a local hospital CKK Chu, EFT Lee, CS Leung, ACH Lit Ambulatory electrocardiography (AECG) or Holter has a long history of use in patients with suspected symptomatic arrhythmia. In Hong Kong, patients with AECG monitoring were entirely under the care of internal medicine in the past. This report described a pioneer trial on the use of AECG in a local emergency setting under the supervision of emergency physicians. A departmental guideline for AECG use on suitable patients was drawn up and patients underwent AECG monitoring in the emergency medicine ward. The AECG results were reported preliminarily by emergency physicians and then confirmed with additional comments by cardiologists. This report presented the clinical features, AECG results and clinical outcomes of all patients recruited from the start of the protocol in May 2008 to July (Hong Kong j.emerg.med. 2010;17: ) Keywords: Ambulatory electrocardiography, cardiac arrhythmias, syncope Correspondence to: Chu Kwok Keung, Clarence, MBChB, MRCSEd Princess Margaret Hospital, Accident and Emergency Department, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong chuclarence@gmail.com Lee Fu Tat, Eric, MRCP(UK), FRCSEd, FHKAM(Emergency Medicine) Leung Chin San, MRCSEd, FHKCEM, FHKAM(Emergency Medicine) Lit Chau Hung, Albert, MRCP(UK), FRCSEd, FHKAM(Emergency Medicine) Introduction Ambulatory electrocardiography (AECG/Holter monitoring) was first developed in the 1960s by Holter, as a method for continuous ECG monitoring. Under this method, a portable recorder is attached to the patient via chest electrodes, in which one to three ECG leads could be recorded throughout the day, while the patient carries out his/her usual daily activities. In

2 Chu et al./ambulatory electrocardiography 317 contrast to standard 12 leads ECG which provides a wider-view of the electrocardial activity with a short duration (usually shorter than 30 seconds), AECG provides a narrower view of data but can facilitate the diurnal ECG examination of a patient in response to the change in environmental factors over 24 hours. Clinical indications of AECG have been recommended by the American Heart Association (AHA). 1 The major use of AECG is to assess symptoms which are possibly related to cardiac rhythm disturbances (e.g. episodic dizziness, syncope, near syncope, unexplained/recurrent palpitation etc.). As most of the time, the symptoms or the underlying suspected cardiac arrhythmia is nonsustained and of short duration, the standard ECG can be entirely normal when such patients present to the accident and emergency department (A&E). AECG thus serves as an investigation, aiming for a higher yield of detection of possible cardiac arrhythmia, and its clinical efficacy in this aspect has been well established. 1 Compared to other forms of investigation such as electrophysiological study, the Holter study has been shown in a large prospective randomised trial the ESVEM trial to have equivalent predictive accuracy on the long term prognostic outcome in patients with malignant ventricular tachycardia. 2 Holter is well accepted as a cost-effective and non-invasive investigation with a reasonable yield. Besides detection of arrhythmia, the Holter study is also used in monitoring patients receiving antiarrhythmic therapy and those on pace-maker/ implanted defibrillator, and it can also be used in risk stratification of future cardiac events and prognostic assessment. However, we should bear in mind that the Holter study is not a screening test, and its use should be justified by the occurrence of symptoms and the whole clinical picture. In the setting of emergency medicine, the focus of using Holter is for early detection of possible life-threatening cardiac arrhythmia as a cause of symptoms such as sinus pause in syncope. For the other uses of AECG such as risk and prognostic assessment in those patients having history of significant cardiac event, we would try to refer the cases to cardiologists and medical colleagues for more detailed assessment. For the definition of "suspected arrhythmia-related symptoms" which warrants Holter assessment, there is so far no international consensus. Older studies tended to include palpitations as an arrhythmia-related symptom while recent studies emphasized on the symptoms associated with haemodynamic instability (i.e. syncope/dizziness/presyncope) in order to have a higher yield. 3 Besides, the predictive outcomes were highly variable among different studies. 4-7 Patient selection and methodology Two Holter machines had been introduced to our emergency medicine ward (EMW) since Both of them were from Philips (model 3100A, Digitrak-Plus 24) and consisted of 5 leads. EMW nurses received training from cardiac nurses on the application and technical aspects of the Holter machine. It took about 30 minutes to train a nursing staff to use the device. Any patient with history or symptoms suspicious of arrhythmia in origin, and considered unsafe to wait for an out-patient Holter, would be admitted to the EMW for observation and inpatient Holter investigation. We followed the ACC/ AHA guideline in patient selection. 1 Patients selected were haemodynamically stable, conscious and with a normal standard 12 leads ECG. Inpatient Holter is part of the investigation in our departmental guideline on syncope. Holter studies were usually initiated by consultants, senior medical officers or deputized senior medical officers who were responsible for ward rounds in the EMW. The installation of the Holter machine was done by trained EMW nurses. After 24 hours of monitoring, the Holter machines were sent to the Electronic Diagnostic Unit (EDU) for decoding. The patients would be discharged from the EMW if their clinical conditions were stable and the symptoms subsided. The preliminary Holter reports would be prepared by the emergency physicians who ordered the investigation, within one week. If any dangerous or significant arrhythmia (Table 1) was spotted, the patients would be called back immediately for assessment. Otherwise, the patients would be followed up at the A&E in two weeks time. The cases would be discharged if the A&E follow-up was uneventful. Formal Holter report would

3 318 Hong Kong j. emerg. med. Vol. 17(4) Sep 2010 be prepared by cardiologists within four weeks to confirm the findings of the preliminary Holter reports. The work-flow of arranging the Holter studies was shown in Figure 1. The work-flow of the followup and management of these cases was virtually the same as the current practice of the cardiac team in the Medical and Geriatric department of our hospital. Results Holter studies were done in 41 cases in the period from May 2008 to July 2009; 27 of them were males and 14 were females. Their age ranged from 18 to 86 years with a mean of 59. Nineteen out of the 41 cases have known history of one or more of the following diseases: diabetes mellitus, hypertension, stroke or ischaemic heart disease. All 41 cases were discharged from the EMW uneventfully without adverse event. The Table 1. Examples of dangerous/significant arrhythmias which require immediate call back 1. Sinus pause >3 seconds 2. Type II second degree atrio-ventricular block 3. Ventricular tachycardia 4. Tachy-bradycardia syndrome associated with symptoms 5. Paroxysmal supraventricular tachycardia 6. Paroxysmal atrial fibrillation 7. Multifocal premature ventricular ectopics Figure 1. Workflow of the Holter study.

4 Chu et al./ambulatory electrocardiography 319 presenting symptoms of the patients are shown in Figure 2. The percentages of positive findings (arrhythmia detected) in different presenting symptoms are shown in Table 2. All Holter studies were done during the EMW stay. There was one Holter study which failed reporting due to the presence of artifact noticed upon decoding, and the Holter study was not repeated afterwards. Most of the preliminary Holter reports were finished by emergency physicians within one week and confirmed by cardiologists within four weeks as shown in Table 3. In general, the comments made by emergency physicians in the preliminary Holter reports were comparable to those made by cardiologists. No dangerous arrhythmia was missed in all the preliminary reports. One case reported by the emergency physician as paroxysmal atrial fibrillation was interpreted by the cardiologist as sinus rhythm with premature atrial ectopics. Three cases of prolonged QTc and one case of ST segment depression found by our emergency physician were commented by the responsible cardiologists as "insignificant". The types and outcomes of arrhythmia found in the eight cases with positive Holter findings are listed in Table 4. Figure 3 shows the AECG rhythm strip of one of the cases as an example. None of the cases with abnormal findings required immediate hospital admission after the preliminary Holter report. For the first case in Table 4 which was found to have sinus pause, the patient had already been urgently referred to the medical out-patient clinic on the day of EMW discharge. Her Holter was reported just before her medical OPD appointment, so the patient was not called back for urgent admission. Discussion The number of positive Holter findings was quite significant in our series. Almost one-fifth (19.5%) of the patients were found to have significant cardiac Table 2. The percentage of cases with positive findings Presenting symptom Positive findings in Holter (%) Dizziness 2/5 (40.0%) Syncope/loss of consciousness 4/21 (19.0%) Palpitations 1/6 (16.7%) Combination of symptoms 0/8 (0%) Unexplained fall 1/1 (100%) Total 8/41(19.5%) Figure 2. Presenting symptoms of patients for the Holter study.

5 320 Hong Kong j. emerg. med. Vol. 17(4) Sep 2010 Table 3. Time of completion of preliminary and final Holter reports Number of preliminary reports Number of Holter reports done by EMW physician confirmed by cardiologist Within EMW stay 5/41(12.2%) 5/41 (12.2%) Within 2 days after discharge from EMW 20/41(48.8%) 19/41 (46.3%) Within 7 days after discharge from EMW 34/41(82.9%) 32/41 (78.0%) Within 14 days after discharge from EMW 38/41(92.7%) 37/41 (90.2%) Within 21 days after discharge from EMW 40/41(97.6%) 38/41 (92.7%) Within 28 days after discharge from EMW 40/41(97.6%) 38/41 (92.7%) EMW=Emergency Medicine Ward Table 4. Particulars of the cases with arrhythmia detected Age / sex Presenting symptom Arrhythmia detected by ambulatory ECG Outcome 1 81/F Dizziness Sinus pause > 4.7 sec Referred cardiac OPD Paroxysmal AF Pacemaker inserted subsequently PVC with one episode of R on T 2 79/M Dizziness AV block with R-R interval 2.2 sec Referred medical OPD 6 episodes of ST depression 3 62/M Syncope Daytime sinus bradycardia Follow-up in cardiac OPD (average rate 52, lowest 45) EPS may be considered 4 75/M Syncope Paroxysmal AF Referred medical OPD 5 51/F Syncope Episodes of ST depression mm Referred medical OPD suspicious of ischemic heart disease 6 18/M Syncope Sinus bradycardia (19.5/24 hours) Referred medical OPD for workup Lowest heart rate 30/min lasting 5 min 7 22/M Palpitation Frequent PVC (2473 beats in 24 hours) Referred medical OPD Short run of 4 consecutive PVC 8 75/F Unexplained fall Short run of SVT / atrial ectopics Follow-up in medical OPD AF=atrial fibrillation; AV=atrioventricular; EPS=electrophysiological study; OPD=outpatient clinic; PVC=premature ventricular contraction; SVT=supraventricular tachycardia arrhythmias. The percentage of positive Holter findings in our series was comparable to previous international studies. 3 This suggested the importance of the initiation of Holter investigation in EMW patients. Our experience showed that there were difficulties in correlating patient symptoms with the AECG findings. Although our nursing staff had already emphasized to every patient how and when to record their symptom events, none of the 41 patients pressed the "event" button to record any symptom during the 24 hours Holter studies. Without such record, it would be difficult to conclude whether the arrhythmia detected was directly related to the presenting symptom or just the "background casual arrhythmia". Under-reporting of symptom during AECG has been a well known factor largely affecting the accuracy and yield of AECG assessment. 3 In addition, without comparison to a control group, we failed to prove that introducing Holter in the emergency medicine ward could reduce patients' risk or the number

6 Chu et al./ambulatory electrocardiography 321 of unnecessary admission. However, our result did show that the introduction of EMW Holter enabled an earlier detection of arrhythmia, including some potentially serious arrhythmia such as long sinus pause, and speeded up their management. Moreover, we have shown that conducting Holter monitoring was feasible in the EMW and emergency physicians were competent in analysing the result. It could probably shorten the time for identifying arrhythmia in patients who were not known to have underlying cardiac disease. Conclusion Introducing AECG is feasible in the emergency medicine setting. AECG is useful in assessing patients presenting with potentially arrhythmia-related symptoms. Emergency physicians are competent in identifying arrhythmia in Holter. In collaboration with cardiologists, Holter monitoring is a safe investigation in the EMW. Hopefully, it can minimise the risk of patients by shortening the time to diagnosis and reduce Figure 3. Ambulatory ECG strip for Case 1, showing a long sinus pause.

7 322 Hong Kong j. emerg. med. Vol. 17(4) Sep 2010 unnecessary admissions. However, its success depends very much on careful selection of patients, training of nurses and education of patients to record symptom during the period of monitoring. References 1. Crawford MH, Bernstein SJ, Deedwania PC, DiMarco JP, Ferrick KJ, Garson A Jr, et al. ACC/AHA guidelines for ambulatory electrocardiography: executive summary and recommendations. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the guidelines for ambulatory electrocardiography) Circulation 1999;100(8): The ESVEM trial. Electrophysiologic study versus electrocardiographic monitoring for selection of antiarrhythmic therapy of ventricular tachyarrhythmias. The ESVEM Investigators. Circulation 1989;79(6): Kennedy HL. Long-term (Holter) electrocardiogram recordings. In: Zipes DP, Jalife J, editors. Cardiac electrophysiology: from cell to bedside. Philadelphia: WB Saunders; Bass EB, Curtiss EI, Arena VC, Hanusa BH, Cecchetti A, Karpf M, et al. The duration of Holter monitoring in patients with syncope: is 24 hours enough? Arch Intern Med 1990;150(5): Zeldis SM, Levine BJ, Michelson EL, Morganroth J. Cardiovascular complaint: correlation with cardiac arrhythmias on 24 hour electrocardiographic monitoring. Chest 1980;78(3): Gibson TC, Heitzman MR. Diagnostic efficacy of 24 hour electrocardiographic monitoring for syncope. Am J Cardiol 1984;53(8): Johansson BW. Evaluation of alteration of consciousness and palpitations. In: Wenger NK, Mock MB, Ringquist I, editors. Ambulatory electrocardiographic recording. Chicago: Year Book Medical Publishers; 1981: p

ACC/AHA Guidelines for Ambulatory Electrocardiography: Executive Summary and Recommendations

ACC/AHA Guidelines for Ambulatory Electrocardiography: Executive Summary and Recommendations (Circulation. 1999;100:886-893.) 1999 American Heart Association, Inc. ACC/AHA Practice Guidelines ACC/AHA Guidelines for Ambulatory Electrocardiography: Executive Summary and Recommendations A Report

More information

Clinical Policy: Holter Monitors Reference Number: CP.MP.113

Clinical Policy: Holter Monitors Reference Number: CP.MP.113 Clinical Policy: Reference Number: CP.MP.113 Effective Date: 05/18 Last Review Date: 04/18 Coding Implications Revision Log Description Ambulatory electrocardiogram (ECG) monitoring provides a view of

More information

Holter Monitoring (Ambulatory Electrocardiography) Defined Cardiac Arrhythmia Among Patients Presented with Palpitation in the Primary Care Setting

Holter Monitoring (Ambulatory Electrocardiography) Defined Cardiac Arrhythmia Among Patients Presented with Palpitation in the Primary Care Setting Journal of Family Medicine and Health Care 2017; 3(1): 12-16 http://www.sciencepublishinggroup.com/j/jfmhc doi: 10.11648/j.jfmhc.20170301.13 ISSN: 2469-8326 (Print); ISSN: 2469-8342 (Online) Holter Monitoring

More information

Ambulatory Cardiac Monitors and Outpatient Telemetry Corporate Medical Policy

Ambulatory Cardiac Monitors and Outpatient Telemetry Corporate Medical Policy Ambulatory Cardiac Monitors and Outpatient Telemetry Corporate Medical Policy File Name: Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry File Code: UM.SPSVC.13 Origination: 10/2015 Last

More information

Patient Resources: Arrhythmias and Congenital Heart Disease

Patient Resources: Arrhythmias and Congenital Heart Disease Patient Resources: Arrhythmias and Congenital Heart Disease Overview Arrhythmias (abnormal heart rhythms) can develop in patients with congenital heart disease (CHD) due to thickening/weakening of their

More information

Recurrent Unexplained Palpitations (RUP) Study

Recurrent Unexplained Palpitations (RUP) Study Journal of the American College of Cardiology Vol. 49, No. 19, 2007 2007 by the American College of Cardiology Foundation ISSN 0735-1097/07/$32.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2007.02.036

More information

Clinical Guidance. Extrasystoles in the neonatal period. Author: Peter Lillitos

Clinical Guidance. Extrasystoles in the neonatal period. Author: Peter Lillitos 1 Clinical Guidance Extrasystoles in the neonatal period Author: Peter Lillitos Contents Page 2: Definition of extrasystoles/ectopic beats Page 3: Algorithm of management Page 4-5: Ordering investigations

More information

Cardiac Implanted Electronic Devices Pacemakers, Defibrillators, Cardiac Resynchronization Devices, Loop Recorders, etc.

Cardiac Implanted Electronic Devices Pacemakers, Defibrillators, Cardiac Resynchronization Devices, Loop Recorders, etc. Cardiac Implanted Electronic Devices Pacemakers, Defibrillators, Cardiac Resynchronization Devices, Loop Recorders, etc. The Miracle of Living February 21, 2018 Matthew Ostrom MD,FACC,FHRS Division of

More information

Cardiac Dysrhythmias and Sports

Cardiac Dysrhythmias and Sports Sudden unexpected death during athletic participation is the overriding consideration in advising individuals with dysrhythmias about participation in sports. The incidence of sudden death is 1 to 2 per

More information

Antony French Consultant Cardiologist & Electrophysiologist

Antony French Consultant Cardiologist & Electrophysiologist Antony French Consultant Cardiologist & Electrophysiologist Palpitations Unpleasant awareness of rapid or forceful heart beat Not all tachycardias cause palpitations, and not all palpitations are due to

More information

UNDERSTANDING ELECTROPHYSIOLOGY STUDIES

UNDERSTANDING ELECTROPHYSIOLOGY STUDIES UNDERSTANDING ELECTROPHYSIOLOGY STUDIES Testing and Treating Your Heart s Electrical System A Problem with Your Heart Rhythm The speed and pattern of a heartbeat is called the heart rhythm. The rhythm

More information

Different indications for pacemaker implantation are the following:

Different indications for pacemaker implantation are the following: Patient Resources: ICD/Pacemaker Overview ICD/Pacemaker Overview What is a pacemaker? A pacemaker is a device that uses low energy electrical pulses to prompt the heart to beat whenever a pause in the

More information

Topic: Outpatient Cardiac Telemetry Date of Origin: April Section: Medicine Last Reviewed Date: December 2014

Topic: Outpatient Cardiac Telemetry Date of Origin: April Section: Medicine Last Reviewed Date: December 2014 Medical Policy Manual Topic: Outpatient Cardiac Telemetry Date of Origin: April 2010 Section: Medicine Last Reviewed Date: December 2014 Policy No: 135 Effective Date: February 1, 2014 IMPORTANT REMINDER

More information

as the cause of recurrent syncope 3 allows appropriate management aimed

as the cause of recurrent syncope 3 allows appropriate management aimed Case Report Hellenic J Cardiol 2009; 50: 155-159 The Role of the Implantable Loop Recorder in the Investigation of Recurrent Syncope SKEVOS K. SIDERIS 1, TERESA A. MOUSIAMA 1, PAVLOS N. STOUGIANNOS 1,

More information

Yield of 48-hour Holter monitoring in children with unexplained palpitations and significance of associated symptoms

Yield of 48-hour Holter monitoring in children with unexplained palpitations and significance of associated symptoms 975 ORIGINAL ARTICLE Yield of 48-hour Holter monitoring in children with unexplained palpitations and significance of associated symptoms Rabbia Aman, Ahmad Usaid Qureshi, Masood Sadiq Abstract Objective:

More information

Zio System Publications. Peer-reviewed publications demonstrating the clinical validity and utility of the Zio system

Zio System Publications. Peer-reviewed publications demonstrating the clinical validity and utility of the Zio system Zio System Publications Peer-reviewed publications demonstrating the clinical validity and utility of the Zio system Contents Electrocardiographic Responses to Deer Hunting in Men and Women. Wilderness

More information

PATIENT WITH ARRHYTHMIA IN DENTIST S OFFICE. Małgorzata Kurpesa, MD., PhD. Chair&Department of Cardiology

PATIENT WITH ARRHYTHMIA IN DENTIST S OFFICE. Małgorzata Kurpesa, MD., PhD. Chair&Department of Cardiology PATIENT WITH ARRHYTHMIA IN DENTIST S OFFICE Małgorzata Kurpesa, MD., PhD. Chair&Department of Cardiology Medical University of Łódź The heart is made up of four chambers Left Atrium Right Atrium Left Ventricle

More information

Arrhythmia Care in the DGH What Still Needs to be Done? Dr. Sundeep Puri Consultant Cardiologist

Arrhythmia Care in the DGH What Still Needs to be Done? Dr. Sundeep Puri Consultant Cardiologist Arrhythmia Care in the DGH What Still Needs to be Done? Dr. Sundeep Puri Consultant Cardiologist LOTS!!! This presentation confines itself to the situation in the North West. The views expressed are my

More information

La strategia diagnostica: il monitoraggio ecg prolungato. Michele Brignole

La strategia diagnostica: il monitoraggio ecg prolungato. Michele Brignole La strategia diagnostica: il monitoraggio ecg prolungato Michele Brignole ECG monitoring and syncope In-hospital monitoring Holter Monitoring External loop recorder Remote (at home) telemetry Implantable

More information

Rhythm Control: Is There a Role for the PCP? Blake Norris, MD, FACC BHHI Primary Care Symposium February 28, 2014

Rhythm Control: Is There a Role for the PCP? Blake Norris, MD, FACC BHHI Primary Care Symposium February 28, 2014 Rhythm Control: Is There a Role for the PCP? Blake Norris, MD, FACC BHHI Primary Care Symposium February 28, 2014 Financial disclosures Consultant Medtronic 3 reasons to evaluate and treat arrhythmias

More information

Direct Current (DC) Cardioversion

Direct Current (DC) Cardioversion Page 1 of 10 Direct Current (DC) Cardioversion Introduction This leaflet is to inform you about your planned Direct Current (DC) electrical cardioversion. A cardioversion is an electrical treatment which

More information

National Coverage Determination (NCD) for Cardiac Pacemakers (20.8)

National Coverage Determination (NCD) for Cardiac Pacemakers (20.8) Page 1 of 12 Centers for Medicare & Medicaid Services National Coverage Determination (NCD) for Cardiac Pacemakers (20.8) Tracking Information Publication Number 100-3 Manual Section Number 20.8 Manual

More information

Ambulatory ECG Monitoring. Gill Bouncir Blackpool Victoria Hospital

Ambulatory ECG Monitoring. Gill Bouncir Blackpool Victoria Hospital Ambulatory ECG Monitoring Gill Bouncir Blackpool Victoria Hospital History Developed in late 1950 s as a result of research of Dr Norman Holter TYPES Holter - continuous recording. Event recorder- patient

More information

Clinical Policy Title: Implantable cardiac loop recorders

Clinical Policy Title: Implantable cardiac loop recorders Clinical Policy Title: Implantable cardiac loop recorders Clinical Policy Number: 04.01.05 Effective Date: April 1, 2015 Initial Review Date: November 19, 2014 Most Recent Review Date: November 16, 2016

More information

Arrhythmia Management Joshua M. Cooper, MD, FHRS, FACC

Arrhythmia Management Joshua M. Cooper, MD, FHRS, FACC Arrhythmia Management Joshua M. Cooper, MD, FHRS, FACC Professor of Medicine Director of Cardiac Electrophysiology Temple University Health System Plumbing Electrical System Bradyarrhythmias Sinus Node

More information

Update on Palpitations and AF February 28 th 2018

Update on Palpitations and AF February 28 th 2018 Update on Palpitations and AF February 28 th 2018 Dr Mrinal Andrew Saha MA(Cantab) MBBS FRCP PhD Consultant Interventional Cardiologist GHNHSFT Dr Mrinal Saha Appointed 2010 Special interests: Angioplasty,

More information

Clinical Policy Title: Implantable cardiac loop recorders

Clinical Policy Title: Implantable cardiac loop recorders Clinical Policy Title: Implantable cardiac loop recorders Clinical Policy Number: 04.01.05 Effective Date: April 1, 2015 Initial Review Date: November 19, 2014 Most Recent Review Date: November 16, 2016

More information

Ambulatory Electrocardiography. Holter Monitor Electrocardiography

Ambulatory Electrocardiography. Holter Monitor Electrocardiography Ambulatory Electrocardiography Holter Monitor Electrocardiography Edward K. Chung Ambulatory Electrocardiography Holter Monitor Electrocardiography With 152 Electrocardiograms Springer-Verlag New York

More information

CLINICAL MEDICAL POLICY

CLINICAL MEDICAL POLICY Policy Name: Policy Number: Responsible Department(s): CLINICAL MEDICAL POLICY Single-use Ambulatory Electrocardiographic Monitors (e.g., Zio Patch) MP-076-MD-DE Medical Management Provider Notice Date:

More information

Pediatrics. Arrhythmias in Children: Bradycardia and Tachycardia Diagnosis and Treatment. Overview

Pediatrics. Arrhythmias in Children: Bradycardia and Tachycardia Diagnosis and Treatment. Overview Pediatrics Arrhythmias in Children: Bradycardia and Tachycardia Diagnosis and Treatment See online here The most common form of cardiac arrhythmia in children is sinus tachycardia which can be caused by

More information

Prediction of Life-Threatening Arrhythmia in Patients after Myocardial Infarction by Late Potentials, Ejection Fraction and Holter Monitoring

Prediction of Life-Threatening Arrhythmia in Patients after Myocardial Infarction by Late Potentials, Ejection Fraction and Holter Monitoring Prediction of Life-Threatening Arrhythmia in Patients after Myocardial Infarction by Late Potentials, Ejection Fraction and Holter Monitoring Yu-Zhen ZHANG, M.D.,* Shi-Wen WANG, M.D.,* Da-Yi Hu, M.D.,**

More information

UNDERSTANDING YOUR ECG: A REVIEW

UNDERSTANDING YOUR ECG: A REVIEW UNDERSTANDING YOUR ECG: A REVIEW Health professionals use the electrocardiograph (ECG) rhythm strip to systematically analyse the cardiac rhythm. Before the systematic process of ECG analysis is described

More information

Management strategies for atrial fibrillation Thursday, 20 October :27

Management strategies for atrial fibrillation Thursday, 20 October :27 ALTHOUGH anyone who has had to run up a flight of steps or has had a frightening experience is quite familiar with a racing heartbeat, for the more than 2 million Americans who suffer from atrial fibrillation

More information

Arrhythmias. Pulmonary Artery

Arrhythmias. Pulmonary Artery Arrhythmias Introduction Cardiac arrhythmia is an irregularity of the heart beat that causes the heart to beat too slowly, too fast, or irregularly. There are different types of arrhythmias. Most arrhythmias

More information

physiology 6 Mohammed Jaafer Turquoise team

physiology 6 Mohammed Jaafer Turquoise team 15 physiology 6 Mohammed Jaafer 22-3-2016 Turquoise team Cardiac Arrhythmias and Their Electrocardiographic Interpretation Today, we are going to talk about the abnormal excitation. As we said before,

More information

24-hour ambulatory electrocardiographic monitoring is unhelpful in the investigation of older persons with recurrent falls

24-hour ambulatory electrocardiographic monitoring is unhelpful in the investigation of older persons with recurrent falls Age and Ageing 2005; 34: 382 386 The Author 2005. Published by Oxford University Press on behalf of the British Geriatrics Society. doi:10.1093/ageing/afi108 All rights reserved. For Permissions, please

More information

Asymptomatic WPW Syndrome; Observation or Ablation? 전남대학교병원순환기내과 박형욱

Asymptomatic WPW Syndrome; Observation or Ablation? 전남대학교병원순환기내과 박형욱 Asymptomatic WPW Syndrome; Observation or Ablation? 전남대학교병원순환기내과 박형욱 Let It Be? Vs. Just Do It? Natural history of asymptomatic WPW Incidence of sudden cardiac death in natural history studies involving

More information

Waterproof quality IP X4

Waterproof quality IP X4 Actual size Thanks to its high level of miniaturisation, the R.Test Evolution 3 is compact and lightweight (45 g. batteries included), for total discretion. Its exceptional design ensures high patient

More information

Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: WPW Revised: 11/2013

Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: WPW Revised: 11/2013 Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: WPW Revised: 11/2013 Wolff-Parkinson-White syndrome (WPW) is a syndrome of pre-excitation of the

More information

Clinical Cardiac Electrophysiology

Clinical Cardiac Electrophysiology Clinical Cardiac Electrophysiology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of

More information

CURRICULUM GOALS AND OBJECTIVES CLINICAL CARDIOVASCULAR ELECTROPHYSIOLOGY TRAINING PROGRAM. University of Florida Gainesville, Florida

CURRICULUM GOALS AND OBJECTIVES CLINICAL CARDIOVASCULAR ELECTROPHYSIOLOGY TRAINING PROGRAM. University of Florida Gainesville, Florida CURRICULUM GOALS AND OBJECTIVES CLINICAL CARDIOVASCULAR ELECTROPHYSIOLOGY TRAINING PROGRAM University of Florida Gainesville, Florida 1. Mission Statement To achieve excellence in the training of fourth

More information

Clinical Investigations

Clinical Investigations Clinical Investigations New Real-Time Loop Recorder Diagnosis of Symptomatic Arrhythmia Via Telemedicine Address for correspondence: Eran Leshem-Rubinow, MD Department of Internal Medicine E Tel Aviv Sourasky

More information

PERMANENT PACEMAKERS AND IMPLANTABLE DEFIBRILLATORS Considerations for intensivists

PERMANENT PACEMAKERS AND IMPLANTABLE DEFIBRILLATORS Considerations for intensivists PERMANENT PACEMAKERS AND IMPLANTABLE DEFIBRILLATORS Considerations for intensivists Craig A. McPherson, MD, FACC Associate Professor of Medicine Constantine Manthous, MD, FACP, FCCP Associate Clinical

More information

CLINICAL CARDIAC ELECTROPHYSIOLOGY Maintenance of Certification (MOC) Examination Blueprint

CLINICAL CARDIAC ELECTROPHYSIOLOGY Maintenance of Certification (MOC) Examination Blueprint CLINICAL CARDIAC ELECTROPHYSIOLOGY Maintenance of Certification (MOC) Examination Blueprint ABIM invites diplomates to help develop the Clinical Cardiac Electrophysiology MOC exam blueprint Based on feedback

More information

2017 BDKA Review. Regularity Rate P waves PRI QRS Interpretation. Regularity Rate P waves PRI QRS Interpretation 1/1/2017

2017 BDKA Review. Regularity Rate P waves PRI QRS Interpretation. Regularity Rate P waves PRI QRS Interpretation 1/1/2017 1. 2017 BDKA Review 2. 3. 4. Interpretation 5. QT 6. 7. 8. 9. 10. QT 11. 12. 13. 14. 15. 16. 17. 18. QT 19. 20. QT 21. 22. QT 23. 24. Where are pacer spikes? Before the P wave or before the QRS complex?

More information

Basic Dysrhythmia Interpretation

Basic Dysrhythmia Interpretation Basic Dysrhythmia Interpretation Objectives 2 To understand the Basic ECG To understand the meaning of Dysrhythmia To describe the normal heart conduction system. To describe the normal impulse pathways.

More information

AF in the ER: Common Scenarios CASE 1. Fast facts. Diagnosis. Management

AF in the ER: Common Scenarios CASE 1. Fast facts. Diagnosis. Management AF in the ER: Common Scenarios Atrial fibrillation is a common problem with a wide spectrum of presentations. Below are five common emergency room scenarios and the management strategies for each. Evan

More information

CASE STUDY: THE CLINICAL BENEFIT OF MOBILE CARDIAC OUTPATIENT TELEMETRY. June 22, 2009

CASE STUDY: THE CLINICAL BENEFIT OF MOBILE CARDIAC OUTPATIENT TELEMETRY. June 22, 2009 CASE STUDY: THE CLINICAL BENEFIT OF MOBILE CARDIAC OUTPATIENT TELEMETRY June 22, 2009 Sanjeev Wasson, MD, FACC, Medical Director, Department of Electrophysiology Skagit Valley Medical Center and Skagit

More information

MEDICINAL PRODUCTS FOR THE TREATMENT OF ARRHYTHMIAS

MEDICINAL PRODUCTS FOR THE TREATMENT OF ARRHYTHMIAS MEDICINAL PRODUCTS FOR THE TREATMENT OF ARRHYTHMIAS Guideline Title Medicinal Products for the Treatment of Arrhythmias Legislative basis Directive 75/318/EEC as amended Date of first adoption November

More information

Synopsis of Management on Ventricular arrhythmias. M. Soni MD Interventional Cardiologist

Synopsis of Management on Ventricular arrhythmias. M. Soni MD Interventional Cardiologist Synopsis of Management on Ventricular arrhythmias M. Soni MD Interventional Cardiologist No financial disclosure Premature Ventricular Contraction (PVC) Ventricular Bigeminy Ventricular Trigeminy Multifocal

More information

Predictive value of history taking and physical examination in diagnosing arrhythmias in general practice

Predictive value of history taking and physical examination in diagnosing arrhythmias in general practice Ó The Author 2007. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org. doi:10.1093/fampra/cmm056 Family Practice Advance

More information

EHRA Accreditation Exam - Sample MCQs Cardiac Pacing and ICDs

EHRA Accreditation Exam - Sample MCQs Cardiac Pacing and ICDs EHRA Accreditation Exam - Sample MCQs Cardiac Pacing and ICDs Dear EHRA Member, Dear Colleague, As you know, the EHRA Accreditation Process is becoming increasingly recognised as an important step for

More information

Heart Rhythm Disorders. How do you quantify risk?

Heart Rhythm Disorders. How do you quantify risk? Heart Rhythm Disorders How do you quantify risk? Heart Rhythm Disorders Scale of the Problem 1/2 population will have an episode of transient loss of consciousness (T-LOC) at some stage in their life.

More information

Module 1: Introduction to ECG & Normal ECG

Module 1: Introduction to ECG & Normal ECG Module 1: Introduction to ECG & Normal ECG Importance of Correct anatomical positions Measurements & Morphologies ONLY accurate if Precise anatomical positions adhered to Standardised techniques are used

More information

Electrocardiography for Healthcare Professionals

Electrocardiography for Healthcare Professionals Electrocardiography for Healthcare Professionals Kathryn A. Booth Thomas O Brien Chapter 5: Rhythm Strip Interpretation and Sinus Rhythms Learning Outcomes 5.1 Explain the process of evaluating ECG tracings

More information

FANS Long QT Syndrome Investigation Protocol (including suspected mutation carriers)

FANS Long QT Syndrome Investigation Protocol (including suspected mutation carriers) Clinical Features FANS Long QT Syndrome Investigation Protocol (including suspected mutation carriers) History Syncope or presyncope compatible with ventricular tachyarrhythmia, especially relating to

More information

Clinical and Electrocardiographic Characteristics of Patients with Brugada Syndrome: Report of Five Cases of Documented Ventricular Fibrillation

Clinical and Electrocardiographic Characteristics of Patients with Brugada Syndrome: Report of Five Cases of Documented Ventricular Fibrillation J Arrhythmia Vol 25 No 1 2009 Original Article Clinical and Electrocardiographic Characteristics of Patients with Brugada Syndrome: Report of Five Cases of Documented Ventricular Fibrillation Seiji Takashio

More information

The New England Journal of Medicine

The New England Journal of Medicine Brief Report CLINICAL CONSEQUENCES OF ELECTROCARDIOGRAPHIC ARTIFACT MIMICKING VENTRICULAR TACHYCARDIA BRADLEY P. KNIGHT, M.D., FRANK PELOSI, M.D., GREGORY F. MICHAUD, M.D., S. ADAM STRICKBERGER, M.D.,

More information

UH Case Medical Center Adult Inpatient Telemetry Admission, Transfer and Discharge Guidelines

UH Case Medical Center Adult Inpatient Telemetry Admission, Transfer and Discharge Guidelines UH Case Medical Center Adult Inpatient Telemetry Admission, Transfer and Discharge Guidelines STATEMENT OF PURPOSE: To facilitate appropriate geo-location placement of patients who require telemetry monitoring

More information

University of Wisconsin - Madison Cardiovascular Medicine Fellowship Program UW CCU Rotation Goals and Objectives Goals

University of Wisconsin - Madison Cardiovascular Medicine Fellowship Program UW CCU Rotation Goals and Objectives Goals Goals Learn to coordinate a variety of data from multiple cardiovascular sub-disciplines, e.g. catheterization laboratory, hemodynamic study, non-invasive imaging, nuclear, electrophysiologic, and in combination

More information

Clinical Results with the Dual-Chamber Cardioverter Defibrillator Phylax AV - Efficacy of the SMART I Discrimination Algorithm

Clinical Results with the Dual-Chamber Cardioverter Defibrillator Phylax AV - Efficacy of the SMART I Discrimination Algorithm April 2000 107 Clinical Results with the Dual-Chamber Cardioverter Defibrillator Phylax AV - Efficacy of the SMART I Discrimination Algorithm B. MERKELY Semmelweis University, Dept. of Cardiovascular Surgery,

More information

An Approach to the Patient with Syncope. Guy Amit MD, MPH Soroka University Medical Center Beer-Sheva

An Approach to the Patient with Syncope. Guy Amit MD, MPH Soroka University Medical Center Beer-Sheva An Approach to the Patient with Syncope Guy Amit MD, MPH Soroka University Medical Center Beer-Sheva Case presentation A 23 y.o. man presented with 2 episodes of syncope One during exercise,one at rest

More information

Repetitive narrow QRS tachycardia in a 61-year-old female patient with recent palpitations

Repetitive narrow QRS tachycardia in a 61-year-old female patient with recent palpitations Journal of Geriatric Cardiology (2018) 15: 193 198 2018 JGC All rights reserved; www.jgc301.com Case Report Open Access Repetitive narrow QRS tachycardia in a 61-year-old female patient with recent palpitations

More information

Dos and Don t in Cardiac Arrhythmia. Case 1 -ECG. Case 1. Management. Emergency Admissions. Reduction of TE risk -CHADS 2 score. Hospital Admissions

Dos and Don t in Cardiac Arrhythmia. Case 1 -ECG. Case 1. Management. Emergency Admissions. Reduction of TE risk -CHADS 2 score. Hospital Admissions Emergency Admissions Dos and Don t in Cardiac Arrhythmia Tom Wong, MD, FESC Consultant Cardiologist, Honorary Senior Lecturer Royal Brompton & Harefield Hospitals National Heart and Lung Institute, Imperial

More information

2018 ESC Guidelines for the diagnosis and management of syncope

2018 ESC Guidelines for the diagnosis and management of syncope 2018 ESC Guidelines for the diagnosis and management of syncope Michele Brignole (Chairperson) (Italy); Angel Moya (Co-chairperson) (Spain); Jean-Claude Deharo (France); Frederik de Lange (The Netherlands);

More information

Effectiveness of Telemetry Guidelines in Predicting Clinically Significant Arrhythmias in Hospitalized Patients

Effectiveness of Telemetry Guidelines in Predicting Clinically Significant Arrhythmias in Hospitalized Patients Elmer Press Original Article Effectiveness of Telemetry Guidelines in Predicting Clinically Significant Arrhythmias in Hospitalized Patients Sandeep K. Dhillon a, b, JosephTawil a, Baruch Goldstein a,

More information

Remote Monitoring & the Smart Home of the 21 Century

Remote Monitoring & the Smart Home of the 21 Century Cardiostim EHRA Europace 2016, Nice - June 8-11, 2016 Remote Monitoring & the Smart Home of the 21 Century Antonio Raviele, MD, FESC, FHRS President ALFA -Alliance to Fight Atrial fibrillation- Venezia

More information

Death after Syncope: Can we predict it? Daniel Zamarripa, MD Senior Medical Director December 2013

Death after Syncope: Can we predict it? Daniel Zamarripa, MD Senior Medical Director December 2013 Death after Syncope: Can we predict it? Daniel Zamarripa, MD Senior Medical Director December 2013 Death after Syncope: Can we predict it? Those who suffer from frequent and severe fainting often die suddenly

More information

Atrial fibrillation (AF) is a disorder seen

Atrial fibrillation (AF) is a disorder seen This Just In... An Update on Arrhythmia What do recent studies reveal about arrhythmia? In this article, the authors provide an update on atrial fibrillation and ventricular arrhythmia. Beth L. Abramson,

More information

AF Today: W. For the majority of patients with atrial. are the Options? Chris Case

AF Today: W. For the majority of patients with atrial. are the Options? Chris Case AF Today: W hat are the Options? Management strategies for patients with atrial fibrillation should depend on the individual patient. Treatment with medications seems adequate for most patients with atrial

More information

ECG S: A CASE-BASED APPROACH December 6,

ECG S: A CASE-BASED APPROACH December 6, ECG S: A CASE-BASED APPROACH December 6, 2018 1 Faculty Disclosure Faculty: Lorne Gula MD, FRCPC Professor, Western University Cardiologist, Hearth Rhythm Specialist Director, Electrophysiology Laboratory,

More information

15 16 September Seminar W10O. ECG for General Practice

15 16 September Seminar W10O. ECG for General Practice 15 16 September 2012 Seminar W10O ECG for General Practice Speaker: Ms Natasha Eaton ECG for General Practice Speaker: Natasha Eaton Cardiac CNC Executive Representative Electrocardiography The graphic

More information

Safety of Transvenous Temporary Cardiac Pacing in Patients with Accidental Digoxin Overdose and Symptomatic Bradycardia

Safety of Transvenous Temporary Cardiac Pacing in Patients with Accidental Digoxin Overdose and Symptomatic Bradycardia General Cardiology Cardiology 2004;102:152 155 DOI: 10.1159/000080483 Received: December 1, 2003 Accepted: February 12, 2004 Published online: August 27, 2004 Safety of Transvenous Temporary Cardiac Pacing

More information

Clinical Case 1 A patient with a syncope Panos E. Vardas President Elect of the ESC, Prof of Cardiology, University Hospital of Crete

Clinical Case 1 A patient with a syncope Panos E. Vardas President Elect of the ESC, Prof of Cardiology, University Hospital of Crete Clinical Case 1 A patient with a syncope Panos E. Vardas President Elect of the ESC, Prof. of Cardiology, University Hospital of Crete Case presentation A 64-year-old male smoker, with arterial hypertension

More information

Mission Statement for our Arrhythmia Care

Mission Statement for our Arrhythmia Care Mission Statement for our Arrhythmia Care We are dedicated to provide a compassionate and an outstanding care for patients with cardiac arrhythmias. We will be utilizing the cutting edge and the most advanced

More information

POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY

POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY Original Issue Date (Created): 7/1/2002 Most Recent Review Date (Revised): 2/28/2018 Effective Date: 10/1/2018 POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS

More information

CASE 10. What would the ST segment of this ECG look like? On which leads would you see this ST segment change? What does the T wave represent?

CASE 10. What would the ST segment of this ECG look like? On which leads would you see this ST segment change? What does the T wave represent? CASE 10 A 57-year-old man presents to the emergency center with complaints of chest pain with radiation to the left arm and jaw. He reports feeling anxious, diaphoretic, and short of breath. His past history

More information

MEDICAL POLICY Cardiac Event Monitors/ Cardiac Event Detection

MEDICAL POLICY Cardiac Event Monitors/ Cardiac Event Detection POLICY: PG0039 ORIGINAL EFFECTIVE: 10/01/11 LAST REVIEW: 12/12/17 MEDICAL POLICY Cardiac Event Monitors/ Cardiac Event Detection GUIDELINES This policy does not certify benefits or authorization of benefits,

More information

Management of Arrhythmias The General Practitioners role

Management of Arrhythmias The General Practitioners role Management of Arrhythmias The General Practitioners role Rohan Gunawardena MD, FRCP, FCCP, FACC Consultant Cardiac Electrophysiologist National Hospital of Sri Lanka Arrhythmias not common Palpitations

More information

Bradydysrhythmias and Atrioventricular Conduction Blocks

Bradydysrhythmias and Atrioventricular Conduction Blocks Emerg Med Clin N Am 24 (2006) 1 9 Bradydysrhythmias and Atrioventricular Conduction Blocks Jacob W. Ufberg, MD*, Jennifer S. Clark, MD Department of Emergency Medicine, Temple University School of Medicine,

More information

Arrhythmias and Heart Failure Dr Chris Lang Consultant Cardiologist and Electrophysiologist Royal Infirmary of Edinburgh

Arrhythmias and Heart Failure Dr Chris Lang Consultant Cardiologist and Electrophysiologist Royal Infirmary of Edinburgh Arrhythmias and Heart Failure Dr Chris Lang Consultant Cardiologist and Electrophysiologist Royal Infirmary of Edinburgh Arrhythmias and Heart Failure Ventricular Supraventricular VT/VF Primary prevention

More information

COURSE DESCRIPTION. Rev 2.0 7/2013. Page 1 of 26

COURSE DESCRIPTION. Rev 2.0 7/2013. Page 1 of 26 COURSE DESCRIPTION Ventricular dysrhythmias (arrhythmias) are unique and potentially dangerous cardiac rhythms. They are often associated with Code Blue calls, and life and death situations. The only two

More information

Special health. guide. Hugh Calkins, M.D., and Ronald Berger, M.D., Ph.D. Guide to Understanding. Atrial Fibrillation WITH

Special health. guide. Hugh Calkins, M.D., and Ronald Berger, M.D., Ph.D. Guide to Understanding. Atrial Fibrillation WITH Hugh Calkins, M.D., and Ronald Berger, M.D., Ph.D. Guide to Understanding Atrial Fibrillation WITH Table of Contents Atrial Fibrillation: An Introduction... 1 How AF Affects the Heart... 2 Who Gets AF?...

More information

Incidence and timing of potentially high-risk arrhythmias detected through long term continuous ambulatory electrocardiographic monitoring

Incidence and timing of potentially high-risk arrhythmias detected through long term continuous ambulatory electrocardiographic monitoring Solomon et al. BMC Cardiovascular Disorders (2016) 16:35 DOI 10.1186/s12872-016-0210-x RESEARCH ARTICLE Incidence and timing of potentially high-risk arrhythmias detected through long term continuous ambulatory

More information

Index. cardiology.theclinics.com. Note: Page numbers of article titles are in boldface type.

Index. cardiology.theclinics.com. Note: Page numbers of article titles are in boldface type. Index Note: Page numbers of article titles are in boldface type. A Adenosine in idiopathic AV block, 445 446 Adolescent(s) syncope in, 397 409. See also Syncope, in children and adolescents AECG monitoring.

More information

REtrive. REpeat. RElearn Design by. Test-Enhanced Learning based ECG practice E-book

REtrive. REpeat. RElearn Design by. Test-Enhanced Learning based ECG practice E-book Test-Enhanced Learning Test-Enhanced Learning Test-Enhanced Learning Test-Enhanced Learning based ECG practice E-book REtrive REpeat RElearn Design by S I T T I N U N T H A N G J U I P E E R I Y A W A

More information

Clinical Policy: Microvolt T-Wave Alternans Testing Reference Number: CP.MP.212

Clinical Policy: Microvolt T-Wave Alternans Testing Reference Number: CP.MP.212 Clinical Policy: Reference Number: CP.MP.212 Effective Date: 03/05 Last Review Date: 09/17 See Important Reminder at the end of this policy for important regulatory and legal information. Coding Implications

More information

TOP 3: EMBRACE. Lucy Vieira MD FRCP Neurologist MUHC. N Engl J Med Volume 370(26): June 26, David J.

TOP 3: EMBRACE. Lucy Vieira MD FRCP Neurologist MUHC. N Engl J Med Volume 370(26): June 26, David J. TOP 3: EMBRACE N Engl J Med Volume 370(26):2467-2477 June 26, 2014 David J. Gladstone et al Lucy Vieira MD FRCP Neurologist MUHC Receiving research funds AstraZeneca 2014-2016 Original Article Atrial Fibrillation

More information

Portable, cordless, single-channel ECG Monitor (HCG-801-E) Screening & Self-Monitoring of cardiac events

Portable, cordless, single-channel ECG Monitor (HCG-801-E) Screening & Self-Monitoring of cardiac events Screening & Self-Monitoring of cardiac events Portable, cordless, single-channel ECG Monitor (HCG-801-E) Compact - Cordless - Simple operation - Fast - Discrete www.omron-healthcare.com Taking a closer

More information

Saudi Council for Health Specialties

Saudi Council for Health Specialties Saudi Council for Health Specialties SAUDI BOARD OF INTERNAL MEDICINE Prince Sultan Cardiac Center (PSCC) Cardiac Electrophysiology & Pacing Training Program 1434 / 2013 1 I. Introduction. II. III. IV.

More information

Accepted Manuscript. Comparison of two ambulatory patch ECG monitors: The benefit of the P- wave and signal clarity

Accepted Manuscript. Comparison of two ambulatory patch ECG monitors: The benefit of the P- wave and signal clarity Accepted Manuscript Comparison of two ambulatory patch ECG monitors: The benefit of the P- wave and signal clarity Robert Rho, Mark Vossler, Susan Blancher ARNP, Jeanne E. Poole PII: S0002-8703(18)30106-6

More information

When the rhythm of life is disturbed

When the rhythm of life is disturbed Brugada Syndrome has the capacity to cause abnormal heart rhythms originating in the upper chambers of the heart When the rhythm of life is disturbed Cardiovascular disease continues to be a leading cause

More information

ECG Interpretation Cat Williams, DVM DACVIM (Cardiology)

ECG Interpretation Cat Williams, DVM DACVIM (Cardiology) ECG Interpretation Cat Williams, DVM DACVIM (Cardiology) Providing the best quality care and service for the patient, the client, and the referring veterinarian. GOAL: Reduce Anxiety about ECGs Back to

More information

Is telemetry overused? Is it as helpful as thought?

Is telemetry overused? Is it as helpful as thought? REVIEW CME CREDIT Marshaleen N. Henriques-Forsythe, MD Assistant Professor of Medicine, Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA Lois Kemilembe K. Kamuguisha, MD Department

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Implantable cardioverter defibrillators for the treatment of arrhythmias and cardiac resynchronisation therapy for the treatment of heart failure (review

More information

ACC/AHA PRACTICE GUIDELINES TABLE OF CONTENTS. COMMITTEE MEMBERS MICHAEL H. CRAWFORD, MD, FACC, Chair

ACC/AHA PRACTICE GUIDELINES TABLE OF CONTENTS. COMMITTEE MEMBERS MICHAEL H. CRAWFORD, MD, FACC, Chair Journal of the American College of Cardiology Vol. 34, No. 3, 1999 1999 by the American College of Cardiology and the American Heart Association, Inc. ISSN 0735-1097/99/$20.00 Published by Elsevier Science

More information

Review guidance for patients on long-term amiodarone treatment

Review guidance for patients on long-term amiodarone treatment Review guidance for patients on long-term amiodarone treatment This review guidance document has been produced in response to: 1. Current supply shortages of branded and generic versions of 100mg and 200mg

More information

Chapter 9. Learning Objectives. Learning Objectives 9/11/2012. Cardiac Arrhythmias. Define electrical therapy

Chapter 9. Learning Objectives. Learning Objectives 9/11/2012. Cardiac Arrhythmias. Define electrical therapy Chapter 9 Cardiac Arrhythmias Learning Objectives Define electrical therapy Explain why electrical therapy is preferred initial therapy over drug administration for cardiac arrest and some arrhythmias

More information

A case of convulsion: Brugada syndrome

A case of convulsion: Brugada syndrome Hong Kong Journal of Emergency Medicine A case of convulsion: Brugada syndrome CK Shum, ML Tse, FL Lau, WK Chan A healthy 28-year-old man presented with multiple brief episodes of convulsion. He was found

More information

Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry

Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry Policy Number: 2.02.08 Last Review: 9/2018 Origination: 11/2002 Next Review: 9/2019 Policy Blue Cross and Blue Shield of Kansas City (Blue

More information