The way Richard Trader's business is going does his heart good. It's doing a lot of other hearts good too.
Mr. Trader's RLT Medical Associates is one of a growing number of companies that offers remote monitoring of patients' heart activity, and Baltimore-area physicians say it's one of the best.
Using its own proprietary technology, Timonium-based RLT has built up a sizable local clientele, and now Mr. Trader is eager to expand to other markets.
Mr. Trader's showcase product is a 6 1/2 -ounce programmable monitor, about the size of a transistor radio, that can fit easily in a jacket pocket or hang unobtrusively from a belt loop.
And it's small size can make a big difference in a patient's life, like Susan Vicino's.
By the time the 37-year-old Ellicott City woman began doing business with Mr. Trader's RLT Medical Associates, she had been wrestling for 10 years with a condition that periodically sent her heart racing out of control.
Sometimes the only way to control it was for doctors to stop her heart and use an electric shock to restart it.
For years, she would show up in her cardiologist's office after an episode and would be outfitted with a Holter monitor, a recording device about the size of a laptop computer with wires leading to sensors that would be taped to her chest.
For an entire day -- through work, sleep and caring for her three children -- she would lug around the bulky box in the hopes of recording the abnormal heart rhythms that threatened her life.
And nothing happened.
"When I was on the Holter, I would not be symptomatic," Ms. Vicino said. "It just seemed they could not isolate the arrhythmia."
Finally, after years of fruitless Holter-hoisting, her cardiologist arranged to outfit her with one of RLT's miniature "event recorders."
Unlike the Holter, the RLT device was small enough for her to wear around day after day, week after week, without provoking comments.
She wore it for seven weeks before her symptoms struck. Suddenly her rate jumped to 308 beats a minute. She pushed a button and the monitor started recording a three-minute "snapshot" of the event.
When the episode subsided, she called RLT's 24-hour monitoring service, held the event recorder up to the phone's mouthpiece and played it back. In the RLT offices, a computer translated the sounds into an electrocardiogram, which was transmitted to her doctor.
"Within five minutes he was instructing me to go to the hospital and they had all the information they needed from the event recorder," Ms. Vicino said.
Within days, her condition finally diagnosed, she was wheeled into surgery to sever the extra nerve pathways that were sending erratic signals to her heart.
The first operation failed to relieve the symptoms, so she went on the recorder again. Armed with new data, the doctors tried again in November. She's been symptom-free ever since.
"It really made a difference in my life. I feel like a normal person again," Ms. Vicino said.
Mr. Trader said the origins of the monitor that detected Ms. Vicino's symptoms go back to his previous career at Sinai Hospital, where he was a physician's assistant and technical director of the Intensive Care Unit.
He said he started developing his event recorder in 1985 and finally received approval from the Food and Drug Administration in 1992. He said he holds a patent on the software and financed its development himself. The remote units, which cost about $350 apiece to make, are manufactured by a subcontractor in Hunt Valley.
RLT is not the only company offering remote, lightweight heart monitors, but Mr. Trader said his company has some distinct advantages. One is that his company keeps a telephone bank open 24 hours a day, staffed by a coronary care nurse, he said. Another is that his event recorder includes an embedded microprocessor that lets a physician reprogram it to change the way measurements are taken.
Dr. Robert Wityk, co-director of the division of neurology at Sinai Hospital, said that attribute led him to use one of RLT's monitors in his research on how strokes affect heart rates. Holter monitors could not record EKGs at a fast enough heart rate, he said, but Mr. Trader's device could.
Mr. Trader said that with heart patients his monitors are at least 70 percent accurate in obtaining a diagnosis, compared with 10 percent to 15 percent for Holter monitors, and that they're more economical. He said a month of 24-hour coverage with one of his monitors costs $300 -- about the price of two days on a Holter monitor, a 40-year-old device made by several manufacturers.
The 48-year-old entrepreneur, who left Sinai to take over full-time management of his company last year, said RLT has landed regional contracts for ambulatory monitoring with Cigna, Kaiser Permanente, Columbia Medical Plan and other health care providers. He also has retained a law firm to seek limited partners to expand his service to 20 other major markets nationwide.
Mr. Trader said his marketing studies show a projected international market potential of $180 million a year for ambulatory monitoring. With $600,000 in annual sales and only seven full-time employees, he figures there's plenty of room to grow.
The former Army medic said a public stock offering is possible but that he and his wife, Lynn, want to make sure they retain effective control of the company's expansion. Now his firm typically monitors several hundred patients at any given time, though Mr. Trader said he has the capacity to handle up to 500.
Meanwhile, he's continuing to refine the technology. Where his current monitors use traditional analog phone signals to transmit data, he said, future generations will employ digital signals that can send more information at a faster rate and eliminate "noise" on the line.
But even with today's technology, RLT should enjoy the benefits of being in a growing marketplace.
Dr. Hugh Calkins, chief of the cardiac electrophysiology service at Johns Hopkins Hospital, said ambulatory monitoring is being used more and more as a way to diagnose patients with infrequent symptoms.
"The problem with the Holter monitor is clear. You put it on, it's the best way to make sure the patient is just fine," he said.
But Dr. Calkins said he doubts such monitors will replace the Holter, a standard diagnostic tool for decades.
In some cases, he said, the three-minute snapshot produced by the event recorder isn't as useful as the Holter's 24-hour recording.
While Mr. Trader says the monitors are unique because of their computer chip, Dr. Calkins has his doubts.
"Most companies have some of that programmability. They may have more," he said.
But Dr. Mahmood Alikhan, director of the Towson Heart Center, said RLT is clearly the best of the five or six monitoring companies he's worked with.
"Most services will give you a reasonable transmission. This is a little bit prettier, more crisp," the doctor said. "Where the rubber meets the road, they stand head and shoulders above other people."