Cardiac monitoring for patients with palpitations

Table 2 Main advantages, limitations, and indications of the most commonly used models of cardiac monitoring devices

	Advantages	Disadvantages	Main indications
24 h Holter	Continuous recording	Discomfort for the patient	Very frequent (daily) symptoms
	12 leads with good correlation with surface ECG	Artefacts	Permanent AF rate monitoring
	Low economic cost	Maximum recording of 24-48 h (low diagnostic yield)	Frequent ventricular premature beats
			Risk stratification of (hypertrophic) cardiomyopathies
Skin patches	Continuous recording of 7–14 d	Single use and greater economic cost	Frequent (weekly) symptoms
	Good tolerability for patients	Analysis by external companies	AF detection in cryptogenic stroke (2 wk)
		Only one lead1
External loop recorders	Loop recording (includes beginning and end of arrhythmic event)	Patient discomfort	Occasional symptoms (monthly)
	4 wk monitoring	Requires education from healthcare professional on how to correctly place the electrodes	AF detection in cryptogenic stroke (2–4 wk)
	High yield and efficiency in the assessment of palpitations
Implantable loop recorder	Loop recording	Invasiveness and associated complications (infection, bleeding, etc.)	Very infrequent symptoms
	Up to 3-yr monitoring (good diagnostic yield)	Individual economic cost	AF detection in at-risk patients (cryptogenic stroke, post-ablation, etc.)
	Patient does not have to do anything	Single lead	Syncope
	Remote monitoring
External event recorders/mobile devices	Easy access for the general population	Single lead1	Palpitations work-up
	Possibility of prolonged use (years)	Data management	Population AF screening (not validated)
	Screening for asymptomatic events (AF screening)	Patient has to be involved (not suitable for syncope work-up)
	Remote monitoring

¹There are devices with more leads.

AF: Atrial fibrillation; ECG: Electrocardiogram.