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consumer heart rate monitors

DIY Heart Rate Monitors: How They Work For A-Fib Patients (Part II)

Polar Heart Rate Monitors

Go to: DIY Heart Rate Monitors

by Steve S. Ryan, PhD, Updated April 2015

A-Fib patients sometimes use consumer ‘DIY” Heart Rate Monitors (HRM) when exercising or performing physically demanding activities (For specific models and options, see our article, DIY Heart Rate Monitors & Handheld ECG Monitors Part I.)

How Do DIY Heart Rate Monitors Work?

Basic HRMs use a chest strap to pick up the electrical signals from the heart. However, due to the inherent design of the chest strap, the accuracy is somewhat limited and is no replacement for the signals recorded by a Holter or Event Monitor.

Heart-Rhythm-Monitors-EKG - 325 pix wide at 96 resA HRM keeps track of your heart’s R-R interval or the time between R peaks. Without getting too technical, the R peak on a generic ECG waveform (see the diagram) corresponds to the ventricle beat (depolarization) and has the largest amplitude (height) of the complete waveform.

When the amplitude (picked up as a voltage differential) exceeds a certain threshold, a “beat” is picked up by the chest strap and transmitted wirelessly to the HRM. It is the time between these R peak “beats” that is used by the HRM to determine instantaneous heart rate. It is only going to pick up episodes of arrhythmia as are manifested in ventricle beats (the R on the waveform).

Learn more about the EKG signal, see Steve’s article: Understanding the EKG (ECG) Signal.

So if your arrhythmia manifests itself in funky R activity (higher than normal rate) you will see a corresponding readout on the HRM. In this same light, an irregular or unevenly spaced R peaks will not be picked up by the HRM.

This is one of the fundamental differences in how data is recorded by HRMs (R-R interval) versus Holter/Event Monitors (actual waveform).

In fact, this is what Polar has to say:

Polar products are not designed to detect arrhythmia or irregular rhythms and will interpret them as noise or interference. The computer in the wrist unit will make error corrections, so that arrhythmia beats are not included in the averaged beats per minute. The blinking heart symbol in the face of the unit, however, will continue to show all heart beats received.

In most cases the Polar products will work fine for persons with arrhythmia.

Example PC interface capability of a Polar PC program.

Graphic example PC interface capability of a Polar PC program.

HRM Recording Capability

Most HRMs provide some internal storage recording capability. While lower cost HRMs simply record low, high and average heart rate, upper end models allow you to download heart rate data to your PC.

App-enabled smartphones are changing how this data is viewed, collected and saved for future review.

How To Setup and Use an HRM

On most of the HRMs, you can set a heart rate zone, and the watch monitor (or app-enabled smartphone) will record how long you stayed in that zone.

You could then program a high heart rate zone which you might only enter if you were in A-Fib. That way you could record how long you stayed in A-Fib and what your max heart rate was. This data could be reviewed on the watch monitor (or app-enabled smartphone) without having to download it to a PC.

On HRMs with PC interface capability, you can view data in a graphic form (on some watches/smartphones you can view the graphic data but with lower resolution.) This analyses could tell you when you were at a higher heart rate—A-Fib—and how long you stayed there. Of course these kinds of features require some PC skills, but typically the programs are pretty user friendly. (See the above graphic example of a Polar PC program).

For more, see our article, DIY Heart Rate Monitors & Handheld ECG Monitors.

Shop Amazon.com for Heart Rate Monitors & Handheld ECG monitors for A-Fib Patients. When you use this link, your purchases generate a small commission (at no extra cost to you) which we apply to the maintenance costs of A-Fib.com. Help A-Fib.com become Self-Supporting!

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Last updated: Tuesday, April 14, 2015

Consumer Handheld ECG Monitors

by Steve S. Ryan, PhD, April 2015

This category of consumer monitors has been growing of late. Going beyond just monitoring your heart rate and plus, these units capture data and display it as an ECG (EKG) in real time.

AliveCor AC-009-UA-A Heart Monitor by AliveCorAliveCor with logo

Detects A-Fib. Attaches to the back of your iPhone; ECG is obtained by holding the iPhone and placing at least 1 finger from each hand on the electrodes embedded into the back of the phone case.

Your data is accessible through the AliveECG app, also stored on secure, encrypted servers, so you can view them anywhere and share them with your doctor.

Newest model is 3rd generation (Doctor prescription no longer required).”

The HeartCheck™ PEN handheld ECG device from CardioComm Solutions

Heart Check Pen

The HeartCheck™ PEN handheld ECG device from CardioComm Solutions

The HeartCheck™ PEN handheld ECG device is the only device of its kind cleared by the FDA for consumer use. No prescripton required. (There is second device that does require a prescription to order it, the HeartCheck™ ECG Handheld Monitor.)

The pocket-sized PEN allows you to take heart readings from anywhere, the moment symptoms appear. Then using the USB cable provided, connect the device to your PC and run ‘GEMS™ Home’ program to upload your heart rhythm files containing your ECGs and send it to a physician or ECG Coordinating Center (for a fee). The  ECG Coordinating Center or physician will create an ECG report on your heart analysis identifying any potential issues. The report will be made available on your PC through the GEMS™ Home program.

There’s a good review of the Heart Check pen by  over at LivingWithAtrialFibrillation.com (posted Sept. 2013). Robert goes into great detail about how to “unlock” your device to you can see the actual reading, the costs of reports (the first one is free), and the details about how all this works. There’s even a $20 off discount code if you order from the manufacturer’s website. There’s also a video at:  http://www.theheartcheck.com/products/

Keep in mind that the HeartCheck™ PEN reports aren’t meant to be used for diagnosis in an emergency. Reviews on Amazon.com are mixed, but it may work for you. Read one or both of the reviews mentioned above.

Handheld ECG Monitor CMS-80A from FaceLake (or Contec)

Facelake Hand-Held Single Channel ECG, ECG 80A Link

Facelake Hand-Held ECG 80A (Helps support A-Fib.com)

Note: Read about how Tom Burt used the CMS-80A in his Personal Experience story. He writes, “This came in very handy as a way to inform my EP when I did get out of rhythm. This was done by faxing him a strip of the printout.”

The CMS-80A is a single channel, 12 lead monitor which can provide data via one of three ways: on the unit display, via the thermal printer internal to the unit or via a USB connection to a PC. The printout from the unit offers the easiest and most accurate means to view lead output. While you can view lead output on the display, you will find that it is not to the same level of detail as the printout.

Like most normal ECG monitors, 10 electrodes are attached to the body as follows: 6 suction cup leads to the chest and 4 alligator clip leads to the arms and legs. The unit does not rely on the normal press-on style contacts but rather takes a simpler approach with its reusable contacts. Personally, I [Ed Webb] wasn’t too impressed with the suction cup style contacts as they feel funny and leave a mark as if you had been attacked by an octopus. But they seemed to do the job. The alligator clips, while funky, were quick and easy to attach.

The waveforms presented are not what you would expect from an ECG in your cardiologist’s office, but they can provide the simple basics to make a quick determination whether you are in A-Fib. In particular, by examining the output from Lead II, or perhaps Lead aVF, you can quickly observe the absence of a P wave—one sign that you may be in A-Fib. Additionally, examining R-R intervals and whether they are uniformly spaced can be another means to aid in that determination.

Facelake Hand-Held Single Channel ECG, ECG 80A Link

Facelake Hand-Held ECG 80A

From a practical perspective, it could be that you choose to only attach the alligator leads to your arms and legs and forego using the chest leads. You will obviously not have the data from the chest leads (V1 to V6), but that information may not be needed for A-Fib purposes.

Note: This unit does not require a prescription from your doctor. For more info and to see what the display looks like, use this link to go to Facelake.com. The CMS-80A (ECG-80A) can be purchased directly from Facelake.com and (using our portal link) from Amazon.com.

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 In-Depth Report Of ECG Monitors

For an extensive evaluation of the above three hand-held ECG monitor with multiple photos and scans see James Grier’s Comparison of Handheld, 1-Lead/Channel ECG/EKG Recorders” at  http://www.ndsu.edu/pubweb/~grier/Comparison-handheld-ECG-EKG.html

Report: Comparison of Handheld, 1-lead/Channel ECG/EKG Recorders

I’m pleased to share a great resource for anyone considering one of the newer hand-held ECG monitors. Comparison of handheld, 1-lead/channel ECG / EKG recordersby James W. Grier, Emeritus Professor of Biological Sciences, North Dakota State University. This report is extremely detailed and extensive (and was last updated March 19, 2014).

He tests and compares eleven units, includes multiple photos of each step of testing and multiple print outs of the results. (Jim’s first report was posted in 2006 and has been updated in 2008, 2013, and in March 2014).

It’s the most thorough report on the topic you will find anywhere. (BTW: We hope to get Jim to write an article or two for A-Fib.com about his own A-Fib. (He’s also involved with an upcoming A-Fib medical study about scuba diving that’s being developed by the dive-medical organization, Divers Alert Network, or DAN.)

Jim Grier’s report,Comparison of handheld, 1-lead/channel ECG / EKG recorders includes the three monitors we discuss below. Go to http://www.ndsu.edu/pubweb/~grier/Comparison-handheld-ECG-EKG.html

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Last updated: Saturday, December 10, 2016

FAQs Coping with A-Fib: DIY Heart Rate Monitors

 FAQs Coping with A-Fib: DIY Monitors

See MyPulse by Smart Monitors- long range at Amazon.com

MyPulse (long distance) by Smart Monitors at Amazon.com

17. “I care for my mom who has A-Fib. She is 94 and sees a doctor on a regular basis. She gets A-Fib attacks maybe once every two weeks and usually in the morning. But I work full time. Is there a heart rate monitor my mom can wear that would alert me when her heart rate is over a certain number? That way I can be alerted even when I’m at work.”

Yes, MyPulse by Smart Monitors, Inc. has a solution for you. This is a practical alternative to the expense of a medical monitoring service if you are just interested in simple heart rate data. Most consumer heart rate monitors rely on a chest strap which transmits heart rate data to a wristwatch. The MyPulse Long Range Monitor has a small Repeater device carried by the person wearing the chest strap. The Repeater transmits the data to a Receiver which is connected to a PC/notebook via a USB port. The MyPulse application runs on a PC and provides a graphic display of real time heart rate data.

The software can be configured to provide alerts via email or text message to multiple recipients if a preset heartbeat limit is exceeded.

Here are the cool parts: the software can be configured to provide alerts via email or text message to multiple recipients if a preset heartbeat limit is exceeded (such as might occur if the wearer goes into A-Fib). For the more tech savvy, a PC mirror app on your smart phone lets you view real time heart rate data at anytime, anywhere. Check out the MyPulse website or see the array of MyPulse the Smart Monitors on Amazon.com. For a more in depth discussion see Treatments/Diagnostics: A Primer: Ambulatory Heart Rhythm Monitors.

(Thanks Julie Skarbeck for this important question and to Ed Webb for doing the research and writing about the Smart Monitor.)

Back to FAQs: Coping with Your A-Fib

Guide to DIY Heart Rate Monitors & Handheld ECG Monitors (Part I)

Consumer Heart Rate Monitors (HRMs) and Handheld ECG monitors

by Steve S. Ryan, PhD, Updated December 2016

A-Fib patients sometimes want to monitor their heart rate and pulse when exercising or when performing physically demanding activities (i.e., mowing the lawn, climbing stairs, loading and unloading equipment, etc.). A consumer ‘DIY” monitor or Handheld ECG monitor may meet this need.

Not to be Confused with Optical Fitness Wristbands

The HRM sensors/monitors in this article work by being in contact with the skin. Don’t confuse these with fitness bands like Fitbit that use an optical sensor to shine a light on your skin illuminating your capillaries to measure your pulse. (Most accurate for resting heart rate). To read a comparison test by Tom’s Guide, see Who Has The Most Accurate Heart Rate Monitor? It’s All About Accuracy (Spoiler: top rated was the Polar T7).

 Types of Consumer HRS

We’ve sorted through the plethora of products and brands and recommend several products in a range of prices and features.

Consumer, DIY or ‘Sport’ Heart Rate Monitors (HRM) are designed for runners and other recreational athletes to collect helpful data for lifestyle and training (pace, distance, heart rate, pulse, etc.).

Heartbeat sensors are either attached to a chest band (or arm band) or built-in to wearable technology and paired with a wireless link to a wrist watch or app-enabled smartphone. HRMS are available from sporting goods stores and online from Amazon.com and other sites.

See our quick start list go to Steve’s Top Picks: DIY Heart Rate Monitors for A-Fib Patients on Amazon.com.

The Gold Standard brand for HRMs is Polar. (The first EKG accurate wireless heart rate monitor was invented by Polar back in 1977 as a training tool for the Finnish National Cross Country Ski Team.) You can view the extensive range of Polar products at their website, PolarUSA.com.

Other companies offering consumer ‘Sport Heart Rate Monitors’ include Timex, Garmin, Acumen, Nike, and Cardiosport plus a host of others if you shop around.

To learn how HRMs work, recording capabilities and how they can help A-Fib patients monitor their heart rate, see Part 2 of this article: DIY Heart Rate Monitors: How They Work For A-Fib Patients (Part II).

We’ve Done the Hard Lifting for You

To help you sort through their extensive offerings, I narrowed down the choices to a few basic and advanced wristwatch models, Bluetooth models, and the newer wearable technology each in an array of price points.

Polar FT1 HRM with chest band at A-Fib.com

Polar FT1 HRM with chest band

Wrist Watch Monitors with Chest Band

Consisting of two components, these HRMs use sensors attached to a heart rate strap that wraps around the chest, and sends a wireless signal to the wrist unit. Some models connect with compatible gym equipment using GymLink. (More features = higher prices.) A few to consider:

♥  Polar FT1 Heart Rate Monitor Watch (about $28)
♥  Polar FT7 Fitness Heart Rate Monitor Watch ($69)
  
Polar RS300X Heart Rate Monitor (about $88)
♥  Polar V800 GPS Sports Watch & Activity Tracker (about $360)

GObeat bluetooth

GObeat Bluetooth HRM for use with Smartphones

Bluetooth App-Enabled Sensors for Smartphones

Smartphones are ubiquitous. For many, their smartphone is an essential part of their standard daily gear. So, it’s no wonder that a smartphone can replace the wrist watch monitor.

Today, you can use Bluetooth technology to send the signal from your heart rate chest strap or forearm band to an app-enabled smartphone. Here are a couple to consider:

♥  Polar H7 Bluetooth Smart Heart Rate Sensor (about $49)
♥  60beat BLUE Heart Rate Monitor for iPhone and most newer Androids (about $35)
♥  Jarv Premium Bluetooth® 4.0 Smart Heart Rate Monitor for Android Devices (about $28)
♥  Scosche RHYTHM+ Heart Rate Monitor with Armband (about $80)

Wearable Technology with Wireless Sensors

“Wearable technology” offers a new options for those who find a chest strap uncomfortable or chafing. With these workout clothes, sensors are built in—to a women’s jogging bra or men’s t-shirt. Note: these items replace the chest band only. (There are also HRM caps, headbands and visors). Here are a few examples:

Wearable technology

Wearable technology

♥  Weartech Men’s Gow Smart Sports T-Shirt (Intergrated Cardiac Sensors) ($24-59)
♥  Adidas Men’s Heart Rate Monitoring Techfit Shirt ($59)
♥  Weartech Women’s Gow Smart Sports Bra (Intergrated Cardiac Sensors) ($39-79)
♥  Adidas Heart Rate Monitoring Smart Bra – seamless – white or black (about $59)

Unless sold as a set, you still need a Heart Rate sensor to snap on to the front of the garment (if you are replacing a chest band, you may be able to reuse the sensor) and you will need something to receive the signal—a wrist watch monitor or app-enabled smartphone.

♥   Adidas miCoach Heart Rate Monitor – wireless (about $38)
♥   Polar H7 Bluetooth Smart Heart Rate Sensor (about $49)

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 Types of Handheld ECG Monitors

See “Comparison of handheld, 1-lead/channel ECG / EKG recorders” by James W. Grier, for an extremely detailed report of 14 Handheld ECG Monitors

This category of consumer monitors has been growing of late with ome models having only limited track records. Going beyond just monitoring your heart rate, these units capture data and display it as an ECG (EKG) in real time.

With prices ranging from $99 to $300 you need to consider size (portability) and ease of use compared to price. Again, I’ve selected a few handheld ECG monitors from the plethora of choices.

AliveCor Heart Monitor by AliveCor

Left: AliveCor snap-on unit (3rd generation); Right: AliveECG app on smartphone screen

Excerpt from Patient Review: AliveCor Heart Monitor for SmartPhones by Frances Koepnick:

FDA-cleared for detection of atrial fibrillation (A-Fib), the AliveCor Heart Monitor when combined with its AliveECG App provides a 30-second, one lead electrocardiogram (ECG). In addition to an ECG, this monitor also determines heart rate in beats per minute (BPM).

This easy-to-use device attaches to iPhones (models 4 thru 6) by means of a snap-on phone case. It is also available for some compatible smartphones and mobile devices other than iPhones.

AliveCor ECG reading displayed on smartphone screen

AliveCor ECG reading displayed on smartphone screen

An ECG reading is obtained by holding the iPhone with both hands and placing at least 1 finger from each hand on the electrodes embedded into the back of the phone case. Your data is accessible through the AliveECG app. it’s also stored on AliveCor secure, encrypted servers, so you can view them anywhere and share them with your doctor.

For more specifics on the AliveCor AC-009-UA-A, continue reading our February 2015 report Patient Review: AliveCor Heart Monitor for SmartPhones by Frances Koepnick.

Cost: about $99.

The HeartCheck™ PEN handheld ECG device from CardioComm Solutions

HeartCheck - unlock view 400 pix wide at 96 res

HeartCheck Pen

The HeartCheck™ PEN handheld ECG device is the only device of its kind cleared by the FDA for consumer use. No prescripton required. (A second device, the HeartCheck™ ECG Handheld Monitor does require a prescription to order.)

The pocket-sized PEN allows you to take heart readings from anywhere, the moment symptoms appear. Then using the USB cable provided, connect the device to your PC and run ‘GEMS™ Home’ program to upload your heart rhythm files containing your ECGs and send it to a physician or ECG Coordinating Center (for a fee).

There’s a good review of the Heart Check pen by  over at LivingWithAtrialFibrillation.com (posted Sept. 2013). Robert goes into great detail about how to “unlock” your device so you can see the actual reading, the costs of reports (the first one is free), and the details about how all this works. There’s even a $20 off discount code if you order from the manufacturer’s website.

There are also user videos at: HeartCheck™ ECG PEN Tips and Common Errors

Keep in mind that the HeartCheck™ PEN reports aren’t meant to be used for diagnosis. Reviews on Amazon.com are mixed, but it may work for you. Read one or both of the reviews mentioned above. About $259.

BodiMetrics Performance Monitor review at A-Fib.com

BodiMetrics Performance Monitor

BodiMetrics Performance Monitor

For ECG tracings & more. Stand alone unit captures and displays actual ECG and other vitals in less than 20 seconds. P

alm-size, slips into your pocket or purse. Wireless, syncs with your Android or iPhone. More than just heart activity, set goals with daily reminders, etc. About $280.

 

Heal Force or Creative Easy ECG Monitor PC-80B or Cardio B Palm

Heal Force or Creative Easy ECG Monitor PC-80B review at A-Fib.com

Heal Force or Creative Easy ECG Monitor PC-80B

The PC-80B is a state-of-the-art 1-lead (with the possibility of doing sequential other leads), handheld ECG device with very sophisticated but intuitive and easy-to-use software. Both the device and software have gone through numerous revisions and improvements since the original PC-80 to the point that it is one of the state-of-the-art handheld ECG devices..

PC-80B Startup screen Heart Rate Monitor review at A-Fib.com

PC-80B Startup screen

It is marketed by several different companies: Heal Force PC-80B, Creative Easy ECG Monitor PC-80B and CARDIO-B PALM ECG (with various versions).

It has a large, well-lighted color display (works well in dim lighting), has options for different lengths of recording including continuous (and can even be used like a Holter monitor!) plus options for USB cable, Bluetooth wireless, or ZigBee for uploading records to the computer. The device has both finger contacts and lead-wire cables.

The PC-80B Color and its software is stand-alone and user-managed. It’s up to the user to communicate with their doctor and needs to be somewhat ECG savvy.

For an extensive review see, Report: Comparison of Handheld, 1-lead/Channel ECG/EKG Recorders by James W. Grier, Emeritus Professor of Biological Sciences, North Dakota State University.

Handheld ECG Monitor CMS-80A (FaceLake or Contec Medical Systems)

Facelake Hand-Held Single Channel ECG, ECG 80A Link

Facelake Hand-Held ECG 80A

Note: Read about how Tom Burt used the CMS-80A in his Personal Experience story. He writes, “This came in very handy as a way to inform my EP when I did get out of rhythm. This was done by faxing him a strip of the printout.”

The Contec CMS-80A is a single channel, 12 lead monitor which can provide data via one of three ways: on the unit display, via the thermal printer internal to the unit or via a USB connection to a PC. The printout from the unit offers the easiest and most accurate means to view lead output. While you can view lead output on the display, you will find that it is not to the same level of detail as the printout.

Like most normal ECG monitors, 10 electrodes are attached to the body as follows: 6 suction cup leads to the chest and 4 alligator clip leads to the arms and legs. The unit does not rely on the normal press-on style contacts but rather takes a simpler approach with its reusable contacts. Personally, I [Ed Webb] wasn’t too impressed with the suction cup style contacts as they feel funny and leave a mark as if you had been attacked by an octopus. But they seemed to do the job. The alligator clips, while funky, were quick and easy to attach.

Facelake Hand-Held Single Channel ECG, ECG 80A Link

Thermal paper in Facelake Hand-Held Single Channel ECG, ECG 80A – link

The waveforms presented are not what you would expect from an ECG in your cardiologist’s office, but they can provide the simple basics to make a quick determination whether you are in A-Fib. In particular, by examining the output from Lead II, or perhaps Lead aVF, you can quickly observe the absence of a P wave—one sign that you may be in A-Fib. Additionally, examining R-R intervals and whether they are uniformly spaced can be another means to aid in that determination.

From a practical perspective, it could be that you choose to only attach the alligator leads to your arms and legs and forego using the chest leads. You will obviously not have the data from the chest leads (V1 to V6), but that information may not be needed for A-Fib purposes.

Thermal printout from the Handheld ECG Monitor CMS-80A ECG

Note: This unit does not require a prescription from your doctor. For more info and to see what the display looks like, visit the Contec product information page. The CMS-80A (ECG-80A) can be purchased directly from Facelake.com and other locations online ($299-$380).

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 Remote Smart Monitors

MyPulse Provides Email or Text Message Alerts

Are you worried about a relative in A-Fib whom you can’t be with all the time? There is a long range heart monitor your relative can use which will transmit to you if he/she goes into A-Fib or exceeds a normal heart rate.

MyPulse by Smart Monitors link

MyPulse (home model) by Smart Monitors

If you have a need to monitor a relative’s or friend’s heart rate or want to know if your relative or friend has gone into A-Fib, MyPulse by Smart Monitors, Inc. has a solution for you. (Prices range from  $149 – $495.) This is a practical alternative to the expense of a medical monitoring service if you are just interested in simple heart rate data. Obviously, if there are medical concerns relative to the heart arrhythmia, you should find an appropriate medical monitoring solution in concert with the patient’s cardiologist. But if you are looking for an alternative to a medical service, read on.

Most heart rate monitors rely on a chest strap which transmits heart rate data to a wristwatch, bike computer or even smart phone worn or carried by the individual. The MyPulse Long Range Monitor is no different, but instead of the watch to read the data, it has a small Repeater device which is carried by the individual (or located within 3’ of the person wearing the chest strap). The Repeater transmits the data to a Receiver which is connected to a PC/notebook via a USB port.

The combination of Repeater/Receiver gives the wearer a practical range of throughout the house (the kind of range you would expect to see on a Wi-Fi network for instance) and up to 1000’ if the Receiver has an unobstructed view of the Repeater. The MyPulse application runs on the PC and provides a graphic display of real time heart rate data.

Bluetooth mid range/global range monitor

This is the cool part: the software can be configured to provide alerts via email or text message to multiple recipients (such as a caregiver) if a preset limit is exceeded (such as might occur if the wearer goes into A-Fib). For you more tech savvy people, if you want to run a PC mirror app on your smart phone, you can view the real time heart rate data at anytime, anywhere, and not have to worry about waiting for an alert if a limit is exceeded.

All in all, this is a remote heart rate monitor solution that provides a low cost alternative to a medical monitoring service if you and your cardiologist determine you don’t need such a service. Check out the MyPulse by Smart Monitor, Inc. on their website and from Amazon.com (using our portal link).

March 2015 Update: Additional MyPulse solutions include Bluetooth models: Bluetooth mobilePlus edition monitor, $149 and Advanced home edition bluetooth mid range/global range monitor. $299.

 In-Depth Report Of ECG Monitors

Report: Comparison of Handheld, 1-Lead/Channel ECG/EKG Recorders

I’m pleased to share a great online resource for anyone considering one of the newer hand-held ECG monitors. “Comparison of handheld, 1-Lead/Channel ECG / EKG recorders” by James W. Grier, Emeritus Professor of Biological Sciences, North Dakota State University. This report is extremely detailed and extensive (and was last updated September 2016).

He tests and compares 14 units, includes multiple photos of each step of testing and multiple print outs of the results. It’s the most thorough report on the topic you will find anywhere.

Go to http://www.ndsu.edu/pubweb/~grier/Comparison-handheld-ECG-EKG.html

Resources for this article

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Last updated: Sunday, December 11, 2016

A Primer: Ambulatory Heart Rhythm Monitors

A Primer: Ambulatory/Long-term Heart Rhythm Monitors

By Steve S. Ryan, PhD

ECG pads positioned

Source: www.afa.org.uk patient education brochure

If your arrhythmia is intermittent, your doctor may have you wear a mobile type of heart rhythm monitor to capture the electrical activity of your heart. As a general rule, in order to make a diagnosis of an arrhythmia, some form of electrocardiographic recording (i.e., EKG,) must be made at the time the arrhythmia is occurring.

If an arrhythmia becomes persistent and is present day-in and day-out, as often is the case for A-Fib, the diagnosis is quite easy with a routine EKG done in the physician’s office.

The challenge is when an arrhythmia occurs intermittently (on and off) or is self-limiting. In this case, an EKG performed in between A-Fib episodes can be completely normal. To circumvent this problem, one would go to the next level of evaluation with a long-term monitor.

Long-term monitors

Long-term monitors basically are EKG recorders that patients can take with them (ambulatory). They fall into two major categories: continuous recording (Holter) and intermittent recording (Event).

The Holter Monitor

Mortara H12+ Continuous 12-lead Holter recorder

Mortora H12+ Continuous 12-lead Holter recorder

A Holter Monitor (named after Dr. Norman Holter, go figure) records continuously the EKG of a patient, usually for 24 – 48 hours. More modern Holter units record onto digital flash memory devices. The data are uploaded into a computer where software analyzes the input, counting ECG complexes, calculating summary statistics such as average heart rate, minimum and maximum heart rate, and finding candidate areas in the recording worthy of further study.

The advantage of a Holter is that every single heartbeat during that day is recorded and can be analyzed. The disadvantage is that if an arrhythmia did not happen on that particular day, the Holter data would not be useful.

The Event Monitor

Cardionet wireless event monitor

Cardionet wireless event monitor

An Event Monitor, on the other hand, is a long-term monitor that can be used for up to 30 days or longer. The advantage is that the longer the recording period, the better chance of “catching” an intermittent arrhythmia. The disadvantage is that an Event Monitor must be activated by the patient and downloaded telephonically, a task that requires a certain amount of manual dexterity and may be difficult for some patients.

Some event monitors are patient activated when having an episode and save the last several minutes of data; others detect the irregular heart rate and automatically record the data.

Number of Electrodes

The number and position of electrodes varies by model, but most Holter monitors employ between three and eight, whereas the Event Monitors typically use two. Both the Holter and Event monitors record electrical signals from the heart via a series of electrodes attached to the chest. The Loop (event) monitor is not attached to the patient but is instead pressed to the chest by the patient when experiencing an A-Fib episode.

Implantable ambulatory event monitors

Medtronic Reveal® DX insertable cardiac monitor (ICM) continuously monitors

Medtronic Reveal® DX insertable cardiac monitor (ICM) continuously monitors

Implantable event monitors are also available for those instances where individuals experience such infrequent symptoms that extended monitoring is needed.

These devices are inserted just under the skin in the chest area during an outpatient surgical procedure. The device may remain implanted for over one year.

Implantable loop recorders have the ability to record events either automatically (auto activated) or by manual activation (self-activated).

Real Time Remote Cardiac Recording

CardioNet MCOTos Event wireless event monitor

CardioNet MCOTos Event wireless event monitor

An example of the newer monitoring technologies is the Ambulatory Cardiac Telemetry (ACT), a wireless cardiac telemetry system.  This event monitor is designed for remote arrhythmia monitoring in any location.

A small transmitter worn on the patient sends the ECG data to a portable handheld device where it is analyzed.  If an arrhythmia is identified, the data is automatically transmitted to a Monitoring Center for immediate review. Integrated into a state-of-the-art mobile phone, the ACT provides next generation cardiac arrhythmia monitoring. What’s interesting is the transmitter is a dongle type device worn around the neck with leads placed on the chest. You carry or have available what, in essence, is a mobile phone (it’s actually more than a phone). It is small and not cumbersome.

No patient input is required. Data collected from the monitors is transmitted to the monitoring center via a cellular network, the internet, or over the phone (based on model). Data from the monitors is not intended to be used directly by the patient but rather by the monitoring center and your cardiologist.

Next-Generation: the ‘Smart Band-Aid’ Zio Patch

Steve wearing a Zio Patch

Steve wearing a Zio Patch

The ‘Smart Band-Aid’ provides the next-generation ambulatory cardiac monitoring service with beat-to-beat, real time analysis, automatic arrhythmia detection and wireless ECG transmission.

The sensors in the Band-Aid can be modified to monitor a number of different tasks as they can also provide a comprehensive suite of post-symptom, looping, and auto trigger event monitors as part of its turn-key cardiac event monitoring service.

Additional Reading

For a scholarly review of medical heart rate monitors, see: New Methodologies in Arrhythmia Monitoring by Anderson & Donnelly.

References for this article

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Last updated: Thursday, September 3, 2015

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