Transtelephonic Cardiac Event Recording for Arrhythmia Surveillance
- Written by:
- Elizabeth Charuvastra, R.N.
Edited by: Mona Barmash
Posted: March 11, 1998
For patients who suffer from intermittent cardiac arrhythmias, the development of the new, small, cardiac event recording devices has made life a little easier. Until recently, intermittent heart rhythm disorders have been difficult to capture, because they rarely happen while at the doctor’s office or hospital.
With the use of these portable ECG monitors, it is now possible for a patient to record the ECG at the time symptoms are actually happening.
These new devices are not only smaller and easier to use, but the quality of the ECG tracings are much clearer making the diagnosis of an arrhythmia much more reliable.
When a physician suspects the presence of a cardiac arrhythmia, he/she may order cardiac event recording in order to document the ECG at the time symptoms are occurring. Depending upon the type of symptoms and the patient’s history, one of the two types of ECG recording devices is prescribed.
Types of Monitors
The Looping Memory Monitor is an ECG recording device that is about the size of a pager. It is attached to the chest with two electrodes with an adhesive backing that sticks to the skin over a long period of time. The electrodes have snaps on them, so that the lead wires from the monitor can be easily snapped on. During bathing or swimming, the monitor is detached, as it is not waterproof, but the adhesive electrodes remain on the chest (they are waterproof and can be dried off before the monitor is re-attached). The electrodes are disposable and can be changed according to the preference of each individual. They are usually changed every three or four days. A supply of electodes and fresh batteries for the monitor are provided at the beginning of the monitoring period.
When symptoms are felt by the patient, a button on the front of the monitor is pressed to activate the recording process. The advantage of this type of monitor is that it is able to record the ECG for a period of time BEFORE the monitor was activated. This looping memory feature is programmable for each individual patient. For example, if a patient is experiencing fainting episodes, the monitor can be programmed to record up to five minutes before the monitor was activated. This means that a patient can pass out, wake up after a few minutes, press the button on the monitor, and the ECG will have been recorded before, during and after the fainting episode This is also a very useful feature for patients who are suspected of having runs of supraventricular tachycardia, where documenting the onset of the arrhythmia can be of diagnostic value. Transient symptoms, such as those that come and go suddenly can be captured and documented with this type of monitor.
The Post Event Monitors are small ECG recording
devices than can be carried in the purse or pocket until
the onset of symptoms. The ECG monitor is held up to the
chest to make a recording of the ECG at the time that
symptoms are happening. The symptoms best suited to this
type of recording device, are those that last for a
period of a few minutes or more. The patient is probably
the best judge of the nature and duration of symptoms to
make monitoring with this device successful.
This type of monitor is very well suited for use with small children, as it is easy to use.
Parents can use it to monitor infants, too. The wrist watch type of monitoring device is
sometimes used, however, it is not as popular because the quality of the ECG signal is
inconsistent and unreliable.
Once an ECG recording has been made, it
remains in the monitor’s memory until it is
convenient to go to a telephone to transmit the recorded
ECG. This is true of both types of monitors.
The Receiving Center
The receipt of the recorded ECG is the most important part of this diagnostic test. Even though the new technologies in monitoring devices are much better than the older versions, it is still the skill and patience of the nurses and technicians who answer the phone that can make the difference in gaining a good diagnostic result. Many hospitals and doctors’ offices that provide this diagnostic test allow the recorded ECG’s to be transmitted into a recording machine. Sometimes a nurse or technician is available during office hours, leaving the receipt of ECG transmissions on nights and weekends to be taken on a recording machine. Recording machines have many problems, and are not very useful for a patient who has had an arrhythmia event that is of a serious nature, or for patients who are nervous and frightened.
The nurse who takes the ECG transmission, talks to the patient both before and after the transmission, asking the patient to describe the symptoms in his/her own words. A nervous or frightened patient can be reassured if the ECG is normal. If a serious arrhythmia is detected, the nurse can contact the patient’s doctor for further instruction. In the presence of a life threatening arrhythmia, or in the case of very severe symptoms, emergency services are contacted in the patient’s area and the doctor notified immediately. In cases like this, the nurse will stay on the phone with the patient until emergency services arrive.
Nurses who work in an ECG Receiving Center are specially trained in the analysis of complex cardiac arrhythmias. Many have been trained on the critical care units of hospitals, and all follow a set of protocols or guidelines that have been designed to help patients who are having arrhythmias or symptoms that may be related to heart rhythm disorders. There are special sets of guidelines for patients with special needs, such as the very young, the very old, patients who are deaf or blind
Most private insurance companies approve this diagnostic test when prescribed by a physician for medical necessity. The approved monitoring period is usually for 30 days, but additional periods may be approved if requested by the physician. Many insurance carriers do not distinguish between "office hours receiving centers", automated receiving centers, and fully staffed receiving centers that provide trained nurses and technicians 24 hours a day, 7 days a week.
Some HMO organizations have their own "in house" Cardiac Event recording services, while others allow their members to have the service performed by an outside laboratory, but require pre-approval for the procedure.
The cost of a 30 day period of Cardiac Event recording can range from $300-$1,200, with prices being set by each individual institution. Some laboratories allow discounted service for special groups or for high volume users.
Consumer Choices
While cardiac event recording can be a very valuable diagnostic test, the recording and transmission of the ECG over the telephone can be a complicated matter without the right service behind the recording device. As consumers of health care services become more sophisticated, it is important to know what questions to ask about diagnostic tests. The following are examples of questions to be asked when cardiac event recording is prescribed by a physician.
- Who will teach the patient to use the device so that learning takes place before the onset of symptoms?
- Is the device being prescribed for the patient appropriate for the symptoms?
- Who will be receiving the transmissions of the recorded ECG, and what is their training?
- Will there be a qualified person to answer the phone and take ECG transmissions on nights and weekends?
- Will the doctor see each and every recording that is made and transmitted?
- Does the staff at the receiving center know the patient’s history?
- Is a baseline ECG taken so that receiving center staff knows what the normal ECG looks like?
- Is there a special protocol at the receiving center for special groups of patients and or special symptoms?
If the physician’s office, hospital or clinic does not appear to provide a full range of service for the cardiac event recording test, patients need to know that there are several specialty laboratories that provide this service in a very comprehensive and professional manner. The costs are usually the same.
- This article was reviewed prior to publication by:
- Elizabeth Tong, MS, RN, CPNP, FAAN
- Clinical Nurse Specialist, Pediatric Cardiology
- The Medical Center at the University of California, San Francisco
- Jon Young
- Parent
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