The evolving role of ambulatory arrhythmia monitoring in general clinical practice

Purpose: To evaluate the efficacy of various ambulatory electrocardiographic monitors for the diagnosis of arrhythmia-related disorders and to provide recommendations for their use in clinical practice. Data Sources: Studies published since 1988 were identified through search of the MEDLINE database. Study Selection: Studies that met methodologic criteria for minimal bias and had clinical relevance were selected. Data Extraction: Descriptive and analytic data from each study. Data Synthesis: Ambulatory electrocardiographic monitors, specifically-transtelephonic continuous-loop event recorders, are highly effective for establishing a diagnosis in patients with palpitations but are less effective for establishing a diagnosis in patients with syncope. Clinicians may use these devices to monitor for nonsustained ventricular tachycardia in patients at potentially high risk for sudden arrhythmic death; however, few data are available to support this practice. Ambulatory monitors are useful for assessment of the safety and efficacy of antiarrhythmic medications and the recurrence of symptomatic supraventricular arrhythmias. New ambulatory arrhythmia monitoring devices are being developed that may facilitate outpatient management of chronic cardiac disease. Conclusions: Ambulatory electrocardiographic monitors, particularly transtelephonic continuous-loop event recorders, aid in the diagnosis of symptomatic arrhythmias. These devices are also useful for monitoring the effectiveness and safety of antiarrhythmic medications. Guidelines are lacking for use of these devices to assess prognosis in patients at potential risk for sudden arrhythmic death.