Discussion
Telemetry served for many years as a monitoring tool for risk patients, particularly after myocardial infarction, coronary arteries bypass-grafts and iife-tfrreatening arrythmias. The immediate EKG recording in symptomatic patients implies a close collaboration between the physician (cardiologist) and the patient, allowing also the patient to be constantly reassured without repetitive and costly visits to the cardiologist. The newest technology allows for the first time in Europe, a 12 lead recording which is of utmost importance in our experience, as 1 lead, 3 lead or even 9 lead recordings can only diagnose arrythmia's with no recognition of lateral wall infarction( 11).
The TTEKG has always been a useful tool for paroxystic supra-ventricular tachycardia, which can usually be detected in 70% of patients, with a sensitivity of 91% when the patient is symptomatic. In a short randomized published study, the authors were able to demonstrate the superiority of cardiac event recorders( 67% versus 35%), as opposed to 48 hours Holter monitoring in patients with palpitations(1 2). Other authors published the high sensitivity of ST segment changes(95%) when using the TTEKG (7).up to now, in Germany, the mean time between carcliac symptoms and therapeutical intervention was
3.5 hours, which should definitely be reduced with the use of TTEKG, offering a higher chance of recovery with no sequels after myocardical infarctions, with rapid thrombolysis or coronary angioplasty. A first evaluation in the UK lead to the following results: 2563 patients called for a TTEKG consultation out of which 1% was urgent, 18% necessitated a physicians intervention, 12% had no significant condition and 69% had no cardiac-related event(13).
With the P 12 technology, recordings should be performed by laymen, who can then transmit the information to a telephonic Center, which will print out the recording, and fax it to the physician or cardiologist in charge. The recordings seem particularly
reliable for ST-segment and T wave changes, allowing precise diagnosis of acute ischemic event. We are aware of the l5% difference in amplitude recordlng between the TTEKG and the SEKG, but it seems to be irrlevant in acute emergent medicine, as it only reveals hypertrophic changes, that do not impact at the time of the diagnosis and intervention. These changes in recording will also be taken into account for those patients who have a continuous monitoring, and can also be altered by modifying certain recording parameters in the devise itself
Our impressionis that patient are satisfied and reassured, knowing that wherever they are, 24 hours a day, they can self-monitor their EKG and have online advise and diagnosis for any occurring condition. Remains only to be seen whether the personal collaboration between patients and physicians will allow better quality of care, with a significant decrease in cost of care.