{"id":5053,"date":"2013-05-18T15:45:17","date_gmt":"2013-05-18T15:45:17","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/aecg\/"},"modified":"2025-05-13T20:27:58","modified_gmt":"2025-05-13T20:27:58","slug":"aecg","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/aecg\/","title":{"rendered":"Indications for Ambulatory Electrocardiography (AECG)"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>There are numerous potential clinical uses of the 12-lead ECG. The ECG may reflect changes associated with primary or secondary myocardial processes (e.g., those associated with coronary artery disease, hypertension, cardiomyopathy, or infiltrative disorders), metabolic and electrolyte abnormalities, and therapeutic or toxic effects of drugs or devices. Electrocardiography serves as the gold standard for the noninvasive diagnosis of arrhythmias and conduction disturbances, and it occasionally is the only marker for the presence of heart disease.<br \/>\n<!--more--><br \/>\nThe recommendations are classified according to the system used by the ACC and AHA. The classification system is as follows:<\/p>\n<ul>\n<li><span style=\"line-height: 1.3em;\">Class I: Conditions for which there is evidence and\/or general agreement that a given procedure or treatment is useful and effective.<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Class II: Conditions for which there is conflicting evidence and\/or a divergence of opinion about the usefulness\/efficacy of a procedure or treatment. Class IIa:The weight of evidence\/opinion is in favor of usefulness\/efficacy. Class IIb:The usefulness\/efficacy is less well established by evidence\/opinion.<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Class III: Conditions for which there is evidence and\/or general agreement that the procedure\/treatment is not useful\/effective, and in some cases may be harmful.<\/span><\/li>\n<\/ul>\n<p><strong>Indications for AECG to Assess Symptoms <\/strong><span style=\"line-height: 1.3em;\"><strong>Possibly Related to Rhythm Disturbances<\/strong><\/span><\/p>\n<p>Class I<\/p>\n<ol>\n<li><span style=\"line-height: 1.3em;\">Patients with unexplained syncope, near syncope, or <\/span><span style=\"line-height: 1.3em;\">episodic dizziness in whom the cause is not obvious<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Patients with unexplained recurrent palpitation<\/span><\/li>\n<\/ol>\n<p>Class IIb<\/p>\n<ol>\n<li><span style=\"line-height: 1.3em;\">Patients with episodic shortness of breath, chest <\/span><span style=\"line-height: 1.3em;\">pain, or fatigue that is not otherwise explained<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Patients with neurological events when transient <\/span><span style=\"line-height: 1.3em;\">atrial fibrillation or flutter is suspected<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Patients with symptoms such as syncope, near syncope, <\/span><span style=\"line-height: 1.3em;\">episodic dizziness, or palpitation in whom a <\/span><span style=\"line-height: 1.3em;\">probable cause other than an arrhythmia has been <\/span><span style=\"line-height: 1.3em;\">identified but in whom symptoms persist despite <\/span><span style=\"line-height: 1.3em;\">treatment of this other cause<\/span><\/li>\n<\/ol>\n<p>Class III<\/p>\n<ol>\n<li><span style=\"line-height: 1.3em;\">Patients with symptoms such as syncope, near syncope, <\/span><span style=\"line-height: 1.3em;\">episodic dizziness, or palpitation in whom <\/span><span style=\"line-height: 1.3em;\">other causes have been identified by history, physical <\/span><span style=\"line-height: 1.3em;\">examination, or laboratory tests<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Patients with cerebrovascular accidents, without <\/span><span style=\"line-height: 1.3em;\">other evidence of arrhythmia<\/span><\/li>\n<\/ol>\n<p><strong>Indications for AECG Arrhythmia Detection to\u00a0<span style=\"line-height: 1.3em;\">Assess Risk for Future Cardiac Events in Patients <\/span><span style=\"line-height: 1.3em;\">Without Symptoms From Arrhythmia<\/span><\/strong><\/p>\n<p>Class I<\/p>\n<p style=\"padding-left: 40px;\">None<\/p>\n<p>Class IIb<\/p>\n<ol>\n<li><span style=\"line-height: 1.3em;\">Post-MI patients with LV dysfunction (ejection fraction <\/span><span style=\"line-height: 1.3em;\">&lt;\/=40%)<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Patients with CHF<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Patients with idiopathic hypertrophic cardiomyopathy<\/span><\/li>\n<\/ol>\n<p>Class III<\/p>\n<ol>\n<li><span style=\"line-height: 1.3em;\">Patients who have sustained myocardial contusion<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Systemic hypertensive patients with LV hypertrophy<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Post-MI patients with normal LV function<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Preoperative arrhythmia evaluation of patients for <\/span><span style=\"line-height: 1.3em;\">noncardiac surgery<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Patients with sleep apnea<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Patients with valvular heart disease<\/span><\/li>\n<\/ol>\n<p><strong>Indications for Measurement of Heart Rate Variability (HRV) to Assess\u00a0<span style=\"line-height: 1.3em;\">Risk for Future Cardiac Events in Patients <\/span><span style=\"line-height: 1.3em;\">Without Symptoms From Arrhythmia<\/span><\/strong><\/p>\n<p>Class I<\/p>\n<p style=\"padding-left: 40px;\">None<\/p>\n<p>Class IIb<\/p>\n<ol>\n<li><span style=\"line-height: 1.3em;\">Post-MI patients with LV dysfunction<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Patients with CHF<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Patients with idiopathic hypertrophic cardiomyopathy<\/span><\/li>\n<\/ol>\n<p>Class III<\/p>\n<ol>\n<li><span style=\"line-height: 1.3em;\">Post-MI patients with normal LV function<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Diabetic subjects to evaluate for diabetic neuropathy<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Patients with rhythm disturbances that preclude <\/span><span style=\"line-height: 1.3em;\">HRV analysis (ie, atrial fibrillation)<\/span><\/li>\n<\/ol>\n<p><strong>Indications for AECG to Assess\u00a0<span style=\"line-height: 1.3em;\">Antiarrhythmic Therapy<\/span><\/strong><\/p>\n<p>Class I<br \/>\nTo assess antiarrhythmic drug response in individuals in\u00a0<span style=\"line-height: 1.3em;\">whom baseline frequency of arrhythmia has been characterized <\/span><span style=\"line-height: 1.3em;\">as reproducible and of sufficient frequency to <\/span><span style=\"line-height: 1.3em;\">permit analysis<\/span><\/p>\n<p>Class IIa<\/p>\n<ol>\n<li><span style=\"line-height: 1.3em;\">To detect proarrhythmic responses to antiarrhythmic <\/span><span style=\"line-height: 1.3em;\">therapy in patients at high risk<\/span><\/li>\n<\/ol>\n<p>Class IIb<\/p>\n<ol>\n<li><span style=\"line-height: 1.3em;\">To assess rate control during atrial fibrillation<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">To document recurrent or asymptomatic nonsustained <\/span><span style=\"line-height: 1.3em;\">arrhythmias during therapy in the outpatient <\/span><span style=\"line-height: 1.3em;\">setting<\/span><\/li>\n<\/ol>\n<p>Class III<\/p>\n<p style=\"padding-left: 40px;\">None<\/p>\n<p><strong>Indications for AECG to Assess Pacemaker and <span style=\"line-height: 1.3em;\">Implantable Cardioverter-Defibrillator (ICD) Function<\/span><\/strong><\/p>\n<p>Class I<\/p>\n<ol>\n<li><span style=\"line-height: 1.3em;\">Evaluation of frequent symptoms of palpitation, <\/span><span style=\"line-height: 1.3em;\">syncope, or near syncope to assess device function to <\/span><span style=\"line-height: 1.3em;\">exclude myopotential inhibition and pacemaker mediated <\/span><span style=\"line-height: 1.3em;\">tachycardia and to assist in the programming <\/span><span style=\"line-height: 1.3em;\">of enhanced features such as rate responsivity <\/span><span style=\"line-height: 1.3em;\">and automatic mode switching<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Evaluation of suspected component failure or malfunction <\/span><span style=\"line-height: 1.3em;\">when device interrogation is not definitive <\/span><span style=\"line-height: 1.3em;\">in establishing a diagnosis<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">To assess the response to adjunctive pharmacological <\/span><span style=\"line-height: 1.3em;\">therapy in patients receiving frequent ICD <\/span><span style=\"line-height: 1.3em;\">therapy<\/span><\/li>\n<\/ol>\n<p>Class IIb<\/p>\n<ol>\n<li><span style=\"line-height: 1.3em;\">Evaluation of immediate postoperative pacemaker <\/span><span style=\"line-height: 1.3em;\">function after pacemaker or ICD implantation as an <\/span><span style=\"line-height: 1.3em;\">alternative or adjunct to continuous telemetric <\/span><span style=\"line-height: 1.3em;\">monitoring<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Evaluation of the rate of supraventricular arrhythmias <\/span><span style=\"line-height: 1.3em;\">in patients with implanted defibrillators<\/span><\/li>\n<\/ol>\n<p>Class III<\/p>\n<ol>\n<li><span style=\"line-height: 1.3em;\">Assessment of ICD\/pacemaker malfunction when <\/span><span style=\"line-height: 1.3em;\">device interrogation, ECG, or other available data <\/span><span style=\"line-height: 1.3em;\">(chest radiograph and so forth) are sufficient to <\/span><span style=\"line-height: 1.3em;\">establish an underlying cause\/diagnosis<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Routine follow-up in asymptomatic patients<\/span><\/li>\n<\/ol>\n<p><strong>Indications for AECG for Ischemia Monitoring<\/strong><\/p>\n<p>Class I<\/p>\n<p style=\"padding-left: 40px;\">None<\/p>\n<p>Class IIa<\/p>\n<ol>\n<li><span style=\"line-height: 1.3em;\">Patients with suspected variant angina<\/span><\/li>\n<\/ol>\n<p>Class IIb<\/p>\n<ol>\n<li><span style=\"line-height: 1.3em;\">Evaluation of patients with chest pain who cannot <\/span><span style=\"line-height: 1.3em;\">exercise<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Preoperative evaluation for vascular surgery of patients <\/span><span style=\"line-height: 1.3em;\">who cannot exercise<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Patients with known coronary artery disease (CAD) and atypical chest pain <\/span><span style=\"line-height: 1.3em;\">syndrome<\/span><\/li>\n<\/ol>\n<p>Class III<\/p>\n<ol>\n<li><span style=\"line-height: 1.3em;\">Initial evaluation of patients with chest pain who are <\/span><span style=\"line-height: 1.3em;\">able to exercise<\/span><\/li>\n<li><span style=\"line-height: 1.3em;\">Routine screening of asymptomatic subjects<\/span><\/li>\n<\/ol>\n<p><strong>Indications for Holter Monitoring (24 &#8211; 48 hours)<\/strong><br \/>\nTraditionally, ambulatory monitoring has been used to determine the cause of palpitations and syncope and, to a lesser degree, to identify ventricular ectopy or nonsustained ventricular tachycardia in patients at potential risk for sudden cardiac death. Atrial fibrillation (AF) has become an increasingly important indication for ambulatory monitoring, predominantly as a tool to monitor the efficacy and safety of pharmacological and nonpharmacological therapies. It is also used to identify asymptomatic AF as a potential source of cryptogenic stroke.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li>Crawford MH, Bernstein SJ, Deedwania PC, DiMarco JP, Ferrick KJ, Garson A Jr, Green LA, Greene HL, Silka MJ, Stone PH, Tracy CM, Gibbons RJ, Alpert JS, Eagle KA, Gardner TJ, Gregoratos G, Russell RO, Ryan TH, Smith SC Jr. ACC\/AHA Guidelines for Ambulatory Electrocardiography. A report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines (Committee to Revise the Guidelines for Ambulatory Electrocardiography). Developed in collaboration with the North American Society for Pacing and Electrophysiology. J Am Coll Cardiol. 1999 Sep;34(3):912-48. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/10483977\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Zimetbaum P, Goldman A. Ambulatory arrhythmia monitoring: choosing the right device. Circulation. 2010 Oct 19;122(16):1629-36. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/20956237\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created May 18, 2013.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[26],"tags":[1975,1350,1349,1976,1977,1978,74,73],"class_list":["post-5053","post","type-post","status-publish","format-standard","hentry","category-cardiology","tag-aecg","tag-ambulatorio","tag-ambulatory","tag-ecg","tag-electrocardiografia","tag-electrocardiography","tag-indicaciones","tag-indications"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/5053","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=5053"}],"version-history":[{"count":3,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/5053\/revisions"}],"predecessor-version":[{"id":9308,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/5053\/revisions\/9308"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=5053"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=5053"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=5053"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}