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Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry

The use of patient-activated or autoactivated external ambulatory event monitors (AEMs) OR continuous ambulatory monitors that record and store information for periods longer than 48 hours may be considered medically necessary as a diagnostic alternative to Holter monitoring in the following situations:
Patients who experience infrequent symptoms (less frequently than every 48 hours) suggestive of cardiac arrhythmias (ie, palpitations, dizziness, presyncope, or syncope).
Patients with atrial fibrillation (AF) who have been treated with catheter ablation, and in whom discontinuation of systemic anticoagulation is being considered.
Patients with cryptogenic stroke who have a negative standard workup for AF including a 24-hour Holter monitor (see Policy Guidelines section).

The use of implantable AEMs, either patient-activated or autoactivated, may be considered medically necessary in the following situations:

In the small subset of patients who experience recurrent symptoms so infrequently that a prior trial of other external AEMs has been unsuccessful.
In patients who require long-term monitoring for AF or possible AF (see Policy Guidelines section).

The use of outpatient cardiac telemetry (also known as mobile cardiac outpatient telemetry) as a diagnostic alternative to AEMs in patients who experience infrequent symptoms (less frequently than every 48 hours) suggestive of cardiac arrhythmias (ie, palpitations, dizziness, presyncope, syncope) is considered investigational.

Other uses of AEMs, including outpatient cardiac telemetry and mobile applications, are considered investigational, including but not limited to monitoring asymptomatic patients with risk factors for arrhythmia, monitoring the effectiveness of antiarrhythmic medications, and detection of myocardial ischemia by detecting ST-segment changes.

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