Saturday, June 28, 2014

External Loop Recorder (ELR) gaining edge over traditional Hotler monitors in India

External Loop Recorder (ELR) gaining edge over traditional Hotler monitors in India

·         ELR, a diagnostic tool to capture heart rhythms, is placed on patients for seven-and-a-half days as against Holter monitor which is put only for a day

·         ELR, a simple and convenient device to use, captures wide variety of heart rhythms, hence helps in effective diagnosis

New Delhi: Innovation in healthcare devices industry turned out to be a saviour for Satish Seemar. But for External Loop Recorder (ELR), the cause for his fainting episodes would have never come to light, thus putting him at serious risks of sudden cardiac arrest, which claims lives of 95% of its victicms.

Fainting or Syncope, as known in medical terms, is loss of consciousness. A person who has fainting spells may or may not return to full consciousness depending on whether he has benign or malignant syncope.

When forty-six-year-old Seemar first fainted, he visited a neurologist, but in vain. After a gap of four days, he again experienced the fainting spell. This time, he consulted a cardiologist who put him on a holter monitor, the standard traditional method for 24-hour electrocardiogram (ECG) monitoring. (ECG is performed to assess the electrical function of the heart)

Despite undergoing the test, nothing substantial came out. Perturbed about his condition, Mr Seemar consulted Dr Vanita Arora, Associate Director & Head, Cardiac Electrophysiology Lab and Arrhythmia Services. To determine the cause, he was placed on ELR, results of which were remarkable. He was successfully diagnosed with heart rhythm abnormality, an Arrhythmia in technical terms, and an implantable cardioverter defibrillator (ICD) was placed to cure his life threatening arrhythmia. He has never had loss of consciousness ever since.

“ELR is a diagnostic tool to capture heart rhythms. Already popular in the West, the device is becoming popular in India and gaining an edge over traditional Holter monitoring method due to its efficacy and easy to use features and extended battery life to capture events up to 7days," says Dr Arora.

Holter monitor versus ELR

ELR is a boon for those whose arrhythmic episodes are short-lived and intermittent. As the patient is put on traditional Holter monitor for only a day, such episodes go missed, as had been the case with Mr Seemar. On the other hand, ELRs are more effective as they are placed for seven-and-a-half days, hence taking into account wide range of heart rhythms and abnormalities.
Convenience is another major factor behind the popularity of ELRs. Unlike Holter monitor, who is bulky due to presence of complicated wiring, ELR device is simple as it consists of a patch and a Bluetooth mobile device.

The patch is water proof, so the patients can easily take bath which is not possible in case of holter. As ELR is just a patch connected via bluetooth to the mobile device, mobility is also not an issue. Patients can resume their daily activities of living once the device is placed. When put on holter, patient’s mobility for 24 hours is an issue.

How ELR works?

ELR is placed for seven-and-a-half days as against the holter monitor which is put only for a day. Due to the long duration, wide variety of heart rhythms are captured which helps in proper analysis and diagnosis.

All ELR devices transmit the ECG data via the SIM-enabled mobile device to a hospital or an intermediate service centre, where the data is analysed. The report is then sent to the doctor concernred who after further diagnosis takes a call of implantation of pacemaker in case of Bradycardia (slow heartbeat), ICD in case of Tachycardia (fast heartbeat) or may decide to keep patients on medical therapy. ELRs are very effective and efficient in detecting atrial arrhythmias and flutter i.e. fast heartbeat in the upper chambers of the heart.

Studies suggest that the yield of ELR device is 50—60% as compared to that of Holter device whose yield is just 10%. Reason for the same is the variation of duration for which a patient is put on the two devices. ELR device is a must for patients who fulfill the primary prevention criteria that take into consideration duration of heart attack and ejection fraction etc.

As ELR effectively diagnoses heart rhythms and helps in timely clinical intervention, the diagnostic tool can prove to be of great use in keeping incidences of sudden cardiac arrests at bay in India. In a country where heart-related disorders are growing exponentially, ELR can help save many lives.

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