Table 3.
Indications for arrhythmia monitoring
| Top Priority for Arrhythmia Monitoring | Timeframe of Monitoring |
|---|---|
| 1. Patients resuscitated from cardiac arrest | 1. Until cardioverter-defibrillator device implanted or reversible cause corrected (eg, hyperkalemia) |
| 2. Patients in early phase of acute coronary syndromes (ST-elevation/non–ST-elevation MI, unstable angina), “rule-out” MI | 2. Minimum 24 hours for uncomplicated MI; until 24 hours after complications resolved (e.g., ongoing chest pain) |
| 3. Patients with newly-diagnosed high-risk coronary lesions (eg, critical left main coronary artery stenosis) | 3. Until intervention (e.g., revascularization) |
| 4. Patients after cardiac surgery (record atrial electrogram from epicardial pacer wires with tachycardias of unknown origin) | 4. Minimum 48–72 hours; until hospital discharge in patients at risk for postoperative atrial fibrillation (e.g., history of atrial fibrillation) |
| 5. Patients after nonurgent percutaneous coronary intervention (angioplasty, stenting) with complications in catheterization laboratory (e.g., vessel dissection, no reflow, suboptimal angiographic result) | 5. Minimum 24 hours; longer if arrhythmias or ischemia occur |
| 6. Patients after implantation of automatic defibrillator or pacemaker lead who are pacemaker dependent (ie, unstable or absent rhythm without pacing) | 6. 12–24 hours after implantation |
| 7. Patients with temporary or transcutaneous pacemaker | 7. Until pacing no longer necessary and device removed or replaced with permanent device |
| 8. Patients who have AV block: Wenkebach (unless stable long-term condition), Mobitz II, advanced (2:1 or higher), complete AV block, or new-onset bundle branch block in setting of acute MI | 8. Until block resolves or definitive therapy (e.g., permanent pacemaker) |
| 9. Patients who have arrhythmias complicating WPW syndrome with rapid conduction over an accessory pathway (e.g., atrial fibrillation with rate >150) | 9. Until definitive therapy (usually catheter ablation) |
| 10. Patients who have drug-induced long-QT syndrome | 10. Until proarrhythmic drug discontinued and QTc returned to predrug state and no QT-related arrhythmias |
| 11. Patients who have intra-aortic balloon counterpulsation | 11. Until weaned from intra-aortic balloon pump |
| 12. Patients who have acute heart failure, pulmonary edema | 12. Until signs/symptoms of acute heart failure resolved and no hemodynamically significant arrhythmias for 24 hours |
| 13. Patients who require intensive care (e.g., major trauma, acute respiratory failure, sepsis, shock, pulmonary embolus, major noncardiac surgery, drug overdose) | 13. Until weaned from mechanical ventilation and hemodynamically stable |
| 14. Patients who undergo procedures that require conscious sedation or anesthesia | 14. Until awake, alert, hemodynamically stable |
AV, atrioventricular; MI, myocardial infarction; WPW, Wolff-Parkinson-White.
Adapted from Drew & Funk, 20067