My husband is a fit active man. He had a bad valve repaired at UCLA 10 years ago and had the MAZE procedure done and the heart cut back to size. He had 10 great years, but his heart just have out and has systolic heart failure and is on medications for it. His EF is hovering around 20%. He is getting a defibrillator next week. We have been told that we are working towards transplant. He's had angiograms he's had stress tests. Often if he is too active he will get abnormal heart rhythms and start coughing. Since he is already on medications for abnormal rhythms and isn't passing out, doctors don't seem too concerned. He hasn't had to wear a monitor. Why is the holter not needed? They don't even do EKG's when we go to the office. And, are their different medicines for different type of rhythm abnormalities? This is a general question about when it is important to record rhythms and if it makes a difference if you are already on "optimal medical therapy" (happy to be getting the defibrillator next week).