Holter ECG for pacemaker/defibrillator carriers: what is its role in the era of remote monitoring?

Abstract

Nowadays several diagnostic tools are available to investigate cardiovascular symptoms like palpitations, dizziness and syncope: ECG Holter (or ambulatory ECG, AECG), external and implantable event/loop recorders. Despite this technological burden, many diagnoses are still missed. In the meantime, we are facing an increasing use of implantable devices for cardiac pacing/defibrillation (CIED), which have rapidly evolved from simple pacing/shock boxes to devices including several diagnostic features. However, these functions are not adequately exploited in current clinical practice and several redundant diagnostic tests, like AECG, are still prescribed to CIED carriers, leading to an increase of costs and a delay in final diagnosis. This review is aimed at identifying the current role of AECG in CIED carriers in view of this technological improvement. First, we will briefly present the indications for AECG according to current guidelines. We will then provide a direct comparison of the different diagnostic features provided by AECG (and event/loop recorders) versus automatic diagnostic CIED to highlight the respective pros and cons. This will serve to carefully discuss these indications in view of the results of recent studies on CIED carriers, highlighting the need for proper implantation and follow-up. Eventually, we will provide useful hints to properly analyse AECG in CIED carriers, considering the different behaviours according to the implemented algorithms. We will conclude by suggesting updated indications for AECG.

Accuracy of the pacemaker event recorder versus Holter‐ECG to detect both symptomatic and asymptomatic ventricular arrhythmias

“…The detection algorithms of these devices recognize the QRS complex by its prematurity, number, and coupling of sequential beats. The different pacemaker models are programmed by default with distinct detection thresholds for heart rate and number of consecutive beats …”

A Value of Periodic Intracardiac Electrograms Used in the Remote Monitoring Systems

“…Несмотря на то что многие современные ИАУ обладают способностью самостоятельной диагностики эффективности сти-муляции, нередки случаи позднего выявления этой проблемы, особенно в тех случаях, когда пациент не является зависимым от пейсмейкера. Как правило, дисфункция электродов обнаруживается при проведении электрокардиограммы (ЭКГ) или холтеровского мониторирования ЭКГ [6]. ПВЭГМ, отражая не только электрическую активность, но и маркерный канал, обладает еще большей диагностической силой и позволяет верифицировать ситуации, когда требуется внеплановое тестирование ИАУ (рис.…”

2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients

“…[259][260][261][262][263] Ambulatory rhythm monitoring and/or exercise stress testing may be useful in patients with arrhythmia concerns or symptoms related to activity and to assist with device optimization. [264][265][266][267][275][276][277] It is reasonable to consider lead surveillance with chest X-ray in the acute postimplant period and to consider repeating every 1-3 years according to growth. 241,247 7.…”