Early experience with a novel ambulatory monitor.

Ambulatory electrocardiographic (ECG) monitoring has addressed a wide variety of clinical needs with a wide variety of technical solutions, all with significant shortcomings and limitations. Common technical issues include patient discomfort and susceptibility to motion artifact related to lead wires, and limited data capacity leading to dependence on patient activation for selection of pertinent ECG rhythms for storage. We have been developing a novel ambulatory ECG monitor that addresses several of these issues. Small size and absence of lead wires improve patient comfort and reduce motion artifact but require novel, short ECG vectors. An integral motion sensor assists interpretation of remnant motion artifact. Large storage capacity permits recording of all ECG signals for a day at a time. Simple human factors design permit easy daily replacement of monitors for extended recording. Highly sensitive amplifiers and low artifact provide good-quality signal images, but the short vectors and close proximity to the heart, particularly the atria, result in ECG morphologies that appear different from more familiar recording technologies. We present some examples to illustrate the issues and generate productive discussion.