Cardiac monitoring and devices

Cardiac monitoring is a way of watching the electrical activity of your heart to ensure it is working normally. It looks out for abnormal heart rhythms or irregular beats.

Cardiac monitoring is done by our team of cardiac scientists. Cardiac scientists are healthcare scientists that specialise in cardiology. They work across the hospital in our outpatient department, wards, catheterisation laboratories (cath labs), radiotherapy and theatres.

Ambulatory monitoring

Ambulatory monitoring is when you take a machine home that measures your heart rate and rhythm, or blood pressure over time.

We provide you with a portable monitor that you wear for a certain duration. Depending on what is being investigated, you will be provided with one of the following (and sometimes both):

  • Holter monitor: records your electrocardiogram (ECG) for 24, 48 or 72 hours and can do so for up to one week
  • 24 hour blood pressure monitor: records the blood pressure measurement from your arm automatically during the day and overnight

Ambulatory monitor services are performed at Newham, St Bartholomew’s, The Royal London and Whipps Cross hospitals.

What to expect

We may be able to send the monitor to your home. You will be contacted by the team to arrange delivery and explain the test.

Fitting the cuff takes 15 minutes. You will feel the cuff inflate every 30 minutes during the day and every hour during the night.

You cannot get this monitor wet. You will not be able to shower or bath with it on.

We cannot process the results of this test until the monitor is returned. You need to return the monitor on the day you take it off.

Your blood pressure report will be sent to your clinical team for review and to give you the results.

Patient information

British and Irish Hypertension Society

Device clinic

Cardiac devices are used to treat people with abnormal heart rhythms. At Barts Health, we have the largest cardiac device service in the UK, implanting over 2,500 devices per year, and following-up with over 15,000 patients. 

The different types of devices we implant are:

  • Biventricular pacemaker/cardiac resynchronisation therapy (CRTs): to improve how well the heart beats 
  • Implantable cardioverter defibrillators (ICDs): to prevent the heart from going too fast 
  • Implantable loop recorders (ILRs): to monitor the heart rhythm 
  • Pacemakers: Devices that prevent the heart from going too slowly

Once implanted, we routinely check and gather information from the device. This is either done face-to-face in a device clinic, or remotely via a home monitor. All patients who have a cardiac device implanted will be offered long-term follow up of their device at one of the hospital sites. 

Clinic information

Most follow-ups are done at St Bartholomew’s Hospital. There are also outreach pacemaker clinics at Newham Hospital and Whipps Cross Hospital at least once a week. 

At your device check, you will be seen by a specialised cardiac scientist who will review your device, check that it is working as well as it can and has good battery life. 

Please bring a list of your medications, your doctor’s letters and any questions you may have.

The first follow-up appointment is usually four to six weeks after implant, before mocing to six or twelve-monthly checks, depending on your device. 

For some patients we offer remote monitoring. This allows us to monitor your device without you coming to the hospital. A remote monitor will be supplied to you which will transmit the information from your device directly to the clinic. 

A cardiac scientist will review the information received, much like a face-to-face appointment. If you have a home monitor, it is important to always keep it plugged in and connected. If any urgent issues are detected by remote monitoring, we will try to contact you.

Contact the service

Device clinic
Clinic 5
Floor two
KGV Building
St Bartholomew's Hospital
West Smithfield
London, EC1A 7BE

Opening hours: Monday to Friday, 9am-5pm

Clinical appointments: 0203 465 5855

Technical device information (for patients and health care professionals): 0203 465 5750

Arrhythmia nurses: 0203 765 8844      

Patient information

Remote monitoring

For ICD patients only

Event/shock information
Event/shocks Symptoms after shock Action
1 shock Feel fine immediately Call device clinic during office hours to arrange an appointment
1 shock Check pain or pressure, palpatations, dizziness, confused or unsure Call 999
2 shocks or more in 24 hour period   Call 999

Echocardiography (echo)

An echocardiogram, or "echo", is a scan used to look at the heart and nearby blood vessels. It's a type of ultrasound scan where a small probe is used to send out high-frequency sound waves that create echoes when they bounce off different parts of the body.

Our echo service also holds British Society of Echocardiography (BSE) departmental accreditation, which is a recognised quality mark. Every year, we perform over 60,000 echocardiograms.

Types of scan

 There are different types of echocardiogram:

  • Transthoracic (TTE): non-invasive and generally painless, similar to a baby scan; duration 20-30 minutes
  • Transoesophageal (TOE): semi-invasive type where a scope (long flexible tube) is passed through the mouth and down the gullet (local anaesthetic and sedation are used) to see the inside of the heart without any interference by the surrounding organs; duration 30-40 minutes
  • Stress (SE): primarily used in patients with disease in the heart’s arteries; specific images of the heart are taken at different stages of exercise and recovery –  this can be done by exercising the patient on a treadmill/static bicycle or by the use of specific medication to increase the heart rate; duration 30-40 minutes
  • Contrast: usually of shorter duration than the TTE as the patient would likely have a full scan previously; involves the injection of an echogenic agent to improve the heart’s image.
  • Bubble studies: similar to contrast echocardiogram, however by the injection of agitated saline (to make air bubbles) and allow identification of small holes inside the heart.

Patients may be seen every three or six months or on a yearly basis, depending on their pathology and follow-up plan.

All TTE, contrast and bubble studies can be done at any of our Barts Health NHS Trust hospitals.

TOE and SE are performed at St Bartholomew’s Hospital. On specific occasions, TOE can be done at any of the district general hospitals if departmental conditions and staffing levels allow.

There are also specific clinics to evaluate the heart valves’ function; these are performed at St Bartholomew’s and Whipps Cross hospitals.

There are also specialised clinics for adults with congenital heart disease which are led by specialised doctors and cardiac scientists. These are done at St Bartholomew’s due to the specialisation needed from the cardiac scientists.

Contact the service

Cardiac physiologist
Clinic 3
Ground floor
KGV Building
St Bartholomew's Hospital
West Smithfield,

Opening hours: Monday to Friday, 9am-5pm

Clinic appointments: 0203 765 8454  
Technical information (for patients and clinicians): 0203 765 8154

Patient information

British Heart Foundation

Electrocardiogram (ECG)

An electrocardiogram (ECG) is a quick, simple and painless test that looks at how fast or slow your heart is beating (your heart rate) and how regularly it beats (your heart rhythm).

This is done by placing stickers, known as electrodes, on your chest, wrists and ankles while you lay on a treatment couch.

ECGs are performed at Newham, St Bartholomew’s, The Royal London and Whipps Cross hospitals.

What to expect

The test is performed by a cardiac scientist. You may wish to have a chaperone with you for your test. Please ask a member of the team about this.

You will be asked to remove the clothes from your upper body and will be offered a gown to wear. We do this as the stickers need to be placed specifically over your heart.

If you have hairy chest, we may need to shave the areas they will place the stickers. This is to ensure a good ECG reading is made.

You will be asked to recline on a bed, stay still and relax. Six sticker pads will be attached on your chest, one on each wrists and one on each ankle.

The test normally takes no more than 10 minutes. Your results will be electronically transmitted to your health records for review by your clinical team.  

Patient information

British Heart Foundation