Why are loop cardiac monitors prescribed to patients?

From the Guidelines

Loop cardiac monitors are prescribed to patients to detect and record abnormal heart rhythms (arrhythmias) that occur infrequently or unpredictably, particularly in cases where symptoms such as palpitations, dizziness, or fainting are suspected to be related to cardiac conduction disorders or bradycardia. These small, wearable devices continuously monitor the heart's electrical activity for extended periods, typically 14-30 days, allowing for the capture of sporadic cardiac events that might be missed by shorter-term monitoring methods like 24-hour Holter monitors. The decision to use a loop cardiac monitor is based on the patient's symptoms and the likelihood of capturing an arrhythmic event during the monitoring period, as outlined in the 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay 1. Some key points to consider when prescribing a loop cardiac monitor include:

• The device should be worn continuously except when bathing, and the patient should press the recording button whenever symptoms occur 1.
• The patient should maintain a symptom diary to help correlate recorded events with physical sensations 1.
• The extended monitoring period significantly increases the diagnostic yield compared to shorter monitoring approaches, helping physicians establish appropriate treatment plans including medication adjustments, ablation procedures, or pacemaker implantation based on accurate rhythm correlation with symptoms 1.
• The choice of device is predicated on the frequency of symptoms, with external loop recorders and mobile cardiac outpatient telemetry being suitable options for patients with frequent, spontaneous symptoms potentially related to bradycardia or conduction disorder 1. Overall, loop cardiac monitors are a valuable tool in the diagnosis and management of cardiac arrhythmias, and their use should be guided by the latest clinical guidelines and evidence-based practice 1.

From the Research

Loop Cardiac Monitors Prescription

People are prescribed loop cardiac monitors for various reasons, including:

• Diagnosis of cardiac arrhythmias, which are irregular heartbeats that can be too slow or too fast 2, 3, 4
• Evaluation of symptoms such as syncope, presyncope, or severe palpitations that may be related to arrhythmias 2, 3
• Detection of infrequent arrhythmias that may not be captured by shorter-term monitoring devices like Holter monitors 2, 3, 4
• Monitoring of patients with cryptogenic stroke, paroxysmal atrial fibrillation, or unexplained recurrent syncope 4
• Risk stratification in patients who are candidates for implantable cardioverter defibrillators or pacemakers 4

Benefits of Loop Cardiac Monitors

The use of loop cardiac monitors has several benefits, including:

• High diagnostic yield, especially in patients with symptoms suggestive of significant cardiac arrhythmias 2, 3
• Ability to detect asymptomatic arrhythmias, which can help identify the underlying cause of symptoms like syncope 3
• Prolonged monitoring capabilities, allowing for the detection of infrequent arrhythmias 2, 3, 4
• Non-invasive and relatively low-risk, making them a useful diagnostic tool for patients with suspected arrhythmias 2, 3, 4

Clinical Applications

Loop cardiac monitors have various clinical applications, including:

• Diagnosis and management of cardiac arrhythmias, such as atrial fibrillation, tachycardia, and Brugada syndrome 5
• Monitoring of patients with implantable devices, such as pacemakers and defibrillators 5
• Evaluation of patients with symptoms like syncope, presyncope, or palpitations, to determine the underlying cause and guide treatment 2, 3, 4