LONG-TERM AMBULATORY ECG MONITORING AN ESSENTIAL DIAGNOSTIC TOOL FOR CURRENT TIMES

Ambulatory ECG (AECG) monitoring with diary correlation of symptoms has been proven to provide significant diagnostic, therapeutic and prognostic benefit an arrhythmic cause symptoms. Arrhythmias can range from premature atrial ventricular complexes (APCs/ PVCs usually benign), Atrial Ventricular Fibrillation which causes morbidity mortality. Symptoms such as palpitations, shortness breath, chest pain syncope are common during arrhythmias their frequency determines the choice investigation needed diagnose arrythmia.
 be a manifestation many cardiac non-cardiac diseases. These also include congenital diseases often missed due inadequate monitoring. Since most intermittent they more likely detected extended Other uses ambulatory devices ST segment analysis, heart rate variability, signal averaged ECGs, diurnal QT QTc analysis (including patients long QT) (1) obstructive sleep apnea vectorcardiography (2). factors have shown relation cardiovascular aiding diagnosis various arrhythmias.
 Syncope although mostly benign, could potentially consequence life-threatening arrhythmia in up 20% patients(3). Nonetheless poses disturbance patients’ life definitive is necessary ensure well-being.
 ESC Guidelines on (2018) recommend further testing AECG via Holter monitoring, wearable patch recorder, external internal loop recorders etc. depending after initial examination negative for definite cause.
 (AF) increases risk stroke than five times. diagnosed important hallmark recurrent risk. (7) Many studies demonstrated post chances detecting AF (15% vs 5%) when compared standard An increase incidence arrythmias (atrial high episodes AHRE) seen Permanent Pacemakers should documented by treated accordingly.(4). Uses if was monitored assess efficacy control treatment offer adequate anticoagulation according 2020 fibrillation guidelines. (8)
 Some limitations twenty-four hours recently overcome improvements hardware software technology including adhesive patches wireless telemetry. Newer softer, waterproof electrode free monitors unprecedented mobility ease carrying out daily routine patient. They operate either or streaming (5). were safe effective pandemic even delivered home through mail critically ill patients.(6)
 The advent smart phones added endless potential recording Bluetooth transmission. Smart like OMSHIRTtm advantage being comfortable wear. example Cardiostat equal quality tracings 99% sensitivity specificity better designed R wave (QRS) detection algorithms(7) (8)Studies these newer easily operable mailed homes self-attachment hospital applied machine (6).
 preference over intra (ICM) above mentioned advantages (9). effectiveness longer recordings Implantable Loop Recorder satisfactory following Ablation therapy leading practice updating guideline changes rhythm management(10).
 A recent review article summarized that physicians US had knowledge how based symptoms, prescribing familiarity. Data showed case inconclusive, physician would still repeat same investigation(3).
 In country Pakistan where there limited resources, management way go. This sheds light need utilizing recommended available devices.