Real-time cardiac monitors

Real-time cardiac monitors (RTCMs) are portable computerized devices that use programmed algorithms to perform rapid, readily available online analysis and processing of electrocardiographic (ECG) data. RTCMs are primarily applied for long-term monitoring of ambulatory cardiac outpatients for the purpose of detecting transient abnormal ECG events. A wide variety of RTCM devices is available ranging from limited capacity intermittent recorders that store only selected ECG data, to 24-hour full-disclosure systems that provide ECG complex and to replay this data for subsequent review. Critics of RTCMs suggest that the best algorithms are imperfect and may lead to errors involving potentially lethal arrhythmias, while proponents argue that real-time cardiac monitoring is sufficiently reliable for clinical use. Available data suggest that the devices are safe and particularly with regard to detecting ventricular arrhythmias, clinically reliable. Currently available algorithms cannot analyze atrial fibrillation, pacemaker rhythms, isolated P-waves, junctional rhythms, and atrial ventricular blocks. The advantages and limitations of RTCMs are well described. Their use can be applied to provide satisfactory results in the diagnosis, prognosis, and therapeutic amangement of selected patients.