Which Ambulatory ECG Monitor For Which Patient?

The skeptical cardiologist still feels that KardiaPro has  eliminated  use of long term monitoring devices for most of his afib patients
However not all my afib patients are willing and able to self-monitor their atrial fibrillation using the Alivecor Mobile ECG device. For the Kardia unwilling and  many patients who don’t have afib we are still utilizing lots of long term monitors.
The ambulatory ECG monitoring world is very confusing and ever-changing but I recently came across a nice review of the area in the Cleveland Clinic Journal of Medicine which can be read in its entirety for free here.
This Table summarizes the various options available. I particularly like that they included relative cost. .
The traditional ambulatory ECG device is the “Holter” monitor which is named after its inventor and is relatively inexpensive and worn for 24 to 48 hours.
The variety of available devices are depicted in this nice graphic:

For the last few years we have predominantly been using the two week “patch” type devices in most of our patients who warrant a long term monitor. The Zio is the prototype for this but we are also using the BioTelemetry patch increasingly.
The more expensive mobile cardiac outpatient telemetry (MCOT) devices like the one below from BioTel look a lot like the patches now. The major difference to the patient is that the monitor has to be taken out and recharged every 5 days. In addition, as BioTel techs are reviewing the signal from the device they can notify the patient if the ECG from the patch is inadequate and have them switch to an included lanyard/electrode set-up.

The advantage of the patch monitors is that they are ultraportable, relatively unobtrusive and they monitor continuously with full disclosure.
The patch is applied to the left chest and usually stays there for two weeks (and yes, patients do get to shower during that time) at which time it is mailed back to the company for analysis.
Continuously Monitoring,


2 thoughts on “Which Ambulatory ECG Monitor For Which Patient?”

  1. Hi,
    I just purchased a Wellue DuoEK(TM):
    Did I waste my money? 😉 (It’s OK if I did, I’m a geeky guy, with more money than sense. ;-))
    My interest is in ECG readings throughout an entire night’s sleep. This Wellue DuoEK(TM) thing has a chest strap that will supposed allow hands-free ECG readings.
    Anyway, I haven’t been to your site much in the past, but I’ve always appreciated your very helpful commentary. Keep up the good work!
    Best wishes,
    Mark Bahner

  2. Apple watch 4 is poor at picking up AFIB mine( prior to my cryoablation) would tell me I was in AFIB about 8 hours after I was in AFIB I certainly would not call that much of a warning device but better than nothing for those who can’t tell they are in AFIB, which frankly boggles my mind. But for taking an ECG reading it is every bit as good as the Alivcor and way more convenient you don’t have to do anything special just access the app and take your ECG. I have both and used both extensively and feel very qualified to comment


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