title: Holter ECG for pacemaker/defibrillator carriers: what is its role in the era of remote monitoring?
abstract: Nowadays several diagnostic tools are available to investigate cardiovascular symptoms like palpitations, dizziness and syncope: ECG Holter (or ambulatory ECG, AECG), external and implantable event/loop recorders. Despite this technological burden, many diagnoses are still missed. In the meantime, we are facing an increasing use of implantable devices for cardiac pacing/defibrillation (CIED), which have rapidly evolved from simple pacing/shock boxes to devices including several diagnostic features. However, these functions are not adequately exploited in current clinical practice and several redundant diagnostic tests, like AECG, are still prescribed to CIED carriers, leading to an increase of costs and a delay in final diagnosis. This review is aimed at identifying the current role of AECG in CIED carriers in view of this technological improvement. First, we will briefly present the indications for AECG according to current guidelines. We will then provide a direct comparison of the different diagnostic features provided by AECG (and event/loop recorders) versus automatic diagnostic CIED to highlight the respective pros and cons. This will serve to carefully discuss these indications in view of the results of recent studies on CIED carriers, highlighting the need for proper implantation and follow-up. Eventually, we will provide useful hints to properly analyse AECG in CIED carriers, considering the different behaviours according to the implemented algorithms. We will conclude by suggesting updated indications for AECG.
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Bologna, Italy.
authors.forename: Igor
authors.initials: I
authors.lastname: Diemberger
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Bologna, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Gardini
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Bologna, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Martignani
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ziacchi
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Bologna, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Corzani
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Bologna, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Biffi
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
mesh_terms: D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000628:therapy; D047548:Defibrillators; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation / Q000379:methods / Q000592:standards; D006801:Humans; D017063:Outcome Assessment, Health Care; D010138:Pacemaker, Artificial; D058996:Quality Improvement