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Ashley Ciosek


  • Many monitored pts do not have a true indication
    • Leads to alarm fatigue, unnecessary workups, and is expensive
    • Cost: about $110 per patient per day
  • Telemetry is not a substitute for more frequent vital signs
  • Discuss frequently on rounds: reassess need and indication
  • Select “MAY” for transfers off telemetry and showering off telemetry among stable patients without troponin elevation or new arrythmia
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Clinical Scenario Duration
Cardiac Cardiac
ACS Post-MI 24-48h 48h after revascularization
Vasospastic angina Until symptoms resolve
Any event requiring ICD shocks Remainder of hospitalization
New/unstable atrial tachyarrhythmias Until stable on medical therapies
Chronic AF w/ recurrence of RVR Clinical judgement
Ventricular tachyarrhythmias Until definitive therapy
Symptomatic bradycardia Until definitive therapy
Decompensated CHF Until underlying cause treated
Procedural Procedural
Ablation (regardless of co-morbidities) 12-24h after procedure
Cardiac surgery 48-72h, or until discharge if high risk for decompensation
Non-cardiac major surgery in patient with AF risk factors Until discharge from step-down or ICU
Conscious sedation Until patient awake, alert, HDS
Miscellaneous Miscellaneous
Endocarditis Until clinically stable
CVA 24-48h
Electrolyte derangement (K, Mg) Until normalization
Hemodialysis Clinical judgement
Drug overdose Until free of influence of substance

Notable non-indications

  • Rate-controlled afib + clinically stable
  • Chronic PVCs
  • ESRD on HD
  • PCI for non-ACS indication (e.g. pre-transplant)
  • Non-cardiac chest pain
  • Patient with AICD admitted for non-cardiac condition, non-cardiac surgery, chronic rate-controlled AFib
  • Nearly all non-cardiac conditions (e.g. undifferentiated sepsis, stable GI bleed, alcohol withdrawal) upon transfer out of ICU
  • Patient in hospice/comfort care