Adjunct Professor FRANCESCO RUGGIERO
University of Tor Vergata, Policlinico Militare di Roma, Italy, March 2016
When is a long term ECG recording useful?
First of all for prognostic purpose, to evaluate the state of any formerly diagnosed pathology. Secondly to follow the therapy efficacy (heart rate, effects on ectopic activity etc.). Some ECG Holter software analyzes more technical ECG aspects like the QTc, QT dispersion, heart rate variability, that are useful for both the understanding of autonomic nervous system and the arrhythmic susceptibility. At least, just in the case of pathology with frequent symptoms (daily), there is an indication for diagnostic scope and, even then, a negative test does not exclude the possibility of an arrhythmia.
Which are the indications for an external long term ECG recorder as the AthenaDiaX system?
Such a monitoring system is very patient friendly because it is leadless and easy to place and re-place in case of any detachment. Thus the cardiologist is safe in the application of a seven day recording with no necessity to visit the patient before the end of the recording; meanwhile the patient, adequately informed, is able to manage the device and to control its correct function. Of course it is important to choose strong ECG electrodes, able to grant a durable fit.
Thanks to the possibility of remote data transmission there is no need to collect the device for analysis, so that it is possible for the cardiologist with the help of a nurse or a technician to make more exams in the same time.
Moreover, the software is really easy to use and intuitive: It allows to find an event, within a complete 1 week recording, just looking at the tachogram, because the graphic form is evident (especially using the zoom functions and pointing at the periods of interest). The automatic arrhythmia detection is a good way to review more ECG sections suspicious of arrhythmic events.
The primary indication, accordingly with the ESHRA position paper (Europace (2009) 11, 671–687) is for the detection of pathology (tachy/bradyarrhythmia, unknown atrial fibrillation, atrioventricular or sinus block, ectopic beats) with infrequent or rare symptoms, so especially with diagnostic purpose. In such vision its use is absolutely better than the classic ECG Holter and could be of large use, both in cardiology (palpitations, syncope, breathless) and in neurology (in the case of stroke of unknown origin). In the future, by the hardware and software upgrading, with the use of the accelerometer and skin impedance measurements, HRV, possibility to combine and modify arrhythmia types, the AthenaDiaX system will acquire more sophisticated functions useful in both prognostic purpose and research fields.