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Underutilisation of Ambulatory ECG Monitoring After Stroke and Transient Ischemic Attack

Atrial fibrillation (AF) is the leading cardiac cause of stroke. and its identification after a stroke or transient ischemic attack (TIA) is important for guiding secondary prevention management. However, paroxysmal AF frequently goes undetected and untreated if sufficient ECG monitoring is not performed. This study underscores the need for clinicians and policymakers to address the gap between recent evidence regarding the effectiveness of ECG monitoring for AF detection and real-world practices.

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Medical Papers

The Electrocardiographic Footprints of Atrial Ectopy

The term ectopic means ‘‘out of place” or ‘‘abnormal position” and, in relation to the heart, refers to an early heartbeat, whose origin is from a focus other than the sinus node. They increase in frequency with age and are generally innocent, unless there is an underlying cause. The ECG footprints of atrial ectopy are prematurity and a non-sinus P wave morphology. Additionally, variable AV conduction, post-ectopic compensatory (or otherwise) pauses and QRS widening due to aberrant conduction may all be observed and all should be considered, when interpreting this common electrophysiology phenomenon.

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Medical Papers

The Electrocardiographic Footprints of Ventricular Ectopy

The term ectopic means “out of place” or “abnormal position” and, in relation to the heart, refers to an early or premature heartbeat, whose origin is from a focus other than the sinus node. Ventricular ectopics originate from an irritable focus within the ventricles and clinically they may be asymptomatic or described by the patient as an “extra” beat, “missed” beat or irregular pulse. Ventricular ectopics may occur in groups including bigeminy, trigeminy, couplets and triplets. Very frequent ventricular ectopics may result in a potentially reversible ectopy-mediated cardiomyopathy.

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Medical Papers

One vs three channels – Ambulatory ECG Holter Monitor results

As the technology surrounding Holter monitors continues to evolve, more options becomes available – including Holters with multi-channels, versus one channel patch Holter monitors. Our Medical Director, Dr Harry Mond, looks at the differences between one channel and multi-channel Holter monitors, and which is better for improving confidence in the diagnosis of arrhythmia.

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Medical Papers

Arrhythmic indications for ambulatory ECG monitoring

A cardiac arrhythmia is a rhythm disturbance of the heart which may require investigation using ambulatory electrocardiographic (ECG) monitoring. This may be a 24 hour or greater (Holter) or medium term (events and telemetry) recording which can be up to two weeks. Longer term recording is available as an implantable loop recorder which may last for up to two years. Access the full resource via the link.

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Medical Papers

Non-arrhythmic indications for ambulatory Holter ECG monitoring

There are a number of computerised packages that can measure Holter ECG recordings over a 24 or shorter period. They require high quality tracings and despite being available in a Holter monitor report, none have been found to be useful in routine medical management. Access the full resource via the link.

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Medical Papers

The Footprints of Electrocardiographic Interference: Fact or Artefact

Corporeal and particularly extra-corporeal interference is a very common problem encountered with both resting electrocardiograph (ECG) tracings and ambulatory recordings. When subtle, the artefact can mimic cardiac arrhythmias, leading to incorrect interpretation of the tracings. There is also a complicated interference group, usually due to implanted cardiac electronic pacing devices and neurostimulators. This manuscript will describe the genesis of interference, how an ECG machine or monitor deals with interference and will discuss the common causes of interference. The characteristic patterns will be described and clues provided on how to differentiate subtle artefact from cardiac arrhythmias.

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Medical Papers

2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry

Ambulatory ECG (AECG) telemetry is typically used to evaluate symptoms such as syncope, dizziness, chest pain, palpitations, or shortness of breath, which may correlate with intermittent cardiac arrhythmias. Additionally, AECG is used to evaluate patient response to initiation, revision, or discontinuation of arrhythmic drug therapy and to assess prognosis in specific clinical contexts. The purposes of this statement were (1) to review how contemporary AECG devices acquire and process ECG signals and how they should be interpreted; (2) to review appropriate utilization of these devices in the management of cardiovascular disease; and (3) to promote standards that will improve the accuracy and appropriate use of the AECG in clinical practice.

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Medical Papers

The spectrum of Ambulatory ECG monitoring

The resting 12-lead electrocardiogram is a surface record of the electrical activity of the heart plotted against time with the actual standardised recording of the non-invasive test being an electrocardiograph (ECG). The test has served as the gold standard for arrhythmia recognition. The resting 12-lead ECG, however, gives only a snapshot in time, whereas arrhythmias may be short-lived, paroxysmal and even asymptomatic making documentation difficult. Subsequent advances in electronic engineering, monitoring, storage and miniaturisation have led to the modern sophisticated units, we take for granted today.

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Medical Papers

Usefulness of Ambulatory 7-Day ECG Monitoring for the Detection of Atrial Fibrillation and Flutter After Acute Stroke and Transient Ischemic Attack

Atrial fibrillation and flutter (AF) account for ~ 10% of all strokes and 50% of cardioembolic strokes. Stroke associated with AF carries a poor prognosis as more than 50% of the survivors remain with a severe deficit, and recurrence may be as high as 12% per year. Because anticoagulant treatment dramatically reduces the recurrence rate, detection of this arrhythmia after stroke is essential. Unfortunately, AF remains underdiagnosed as it is often asymptomatic: up to 30% of patients with AF are unaware of their diagnosis, and 25% of those with AF-associated stroke have no prior diagnosis of AF. Moreover, the fibrillation pattern is intermittent in 30% of patients with stroke and may not appear on a single recording.

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