Ambulatory External Electrocardiographic Monitoring
Open accessAbstract
There has been progressive development in ambulatory external electrocardiogram (AECG) monitoring technology. AECG monitors initially consisted of 24- to 48-h Holter monitors and patient-activated event and loop recorders. More recently, several ambulatory cardiovascular telemetry monitors and a patch-type 7- to 14-day Holter monitor have been introduced. These monitoring systems are reviewed along with their utility and limitations, with particular emphasis on their role in the diagnosis and evaluation of patients with atrial fibrillation (AF). AECG monitoring is necessary when asymptomatic AF is suspected (as in patients presenting with cryptogenic stroke) or when an ECG diagnosis of unexplained arrhythmic symptoms is warranted. In addition, AECG plays an important role in patients with known AF to guide ventricular rate control and anticoagulation therapy, and assess the efficacy of antiarrhythmic drug therapy and/or ablation procedures. Finally, we outline areas of uncertainty and provide recommendations for use of available AECG monitors in clinical practice.
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Other arrhythmic causes of symptoms, such as atrial flutter, atrial tachycardia, atrial ectopy, and others can usually be differentiated from AF, especially with multilead recordings.
“In addition, other arrhythmic causes of symptoms, such as atrial flutter, atrial tachycardia, atrial ectopy, and others can usually be differentiated from AF, especially with multilead recordings (Mittal et al., 2011).”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Mittal et al., 2011
The Diagnosis of AF section says prolonged ambulatory ECG recording is valuable for sorting out possible arrhythmic explanations for symptoms. The paper also calls the 12-lead ECG a gold standard for arrhythmia diagnosis. Our copy does not say that atrial flutter, atrial tachycardia, or atrial ectopy can usually be differentiated from AF, or that multilead recordings especially enable this distinction. (LLM, conf=0.82)
Experimental — accuracy not yet measuredExtending ambulatory electrocardiographic monitoring beyond the traditional 24- to 48-hour duration can improve the diagnostic yield of infrequent arrhythmias.
“Continuous ECG monitoring longer than the traditional 24to 48-hour duration might improve the diagnostic yield of infrequent arrhythmias.”
From Diagnostic utility of a novel leadless arrhythmia monitoring device. (2013) · cites this paper as [4]
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- Authors
- Mittal, S., Movsowitz, C., & Steinberg, J. S.
- Affiliations
- Columbia University (US)
- Lankenau Medical Center (US)
- Corresponding author
- Mittal, Suneet
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2011-10
- Volume
- 58
- Issue
- 17
- Pages
- 1741-1749
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W31310327
- Cited by
- 136
- References
- 29
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 5 · 2023: 4 · 2022: 10 · 2021: 10 · 2020: 9 · 2019: 11 · 2018: 6 · 2017: 17 · 2016: 6 · 2015: 10 · 2014: 16 · 2013: 18 · 2012: 6
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- Holter monitoring, event data recorders, loop recorder, atrial fibrillation, cryptogenic stroke, ventricular rate control, anticoagulation, antiarrhythmic efficacy, catheter ablation
- MeSH terms
- Atrial Fibrillation, Humans, Telemetry, Electrocardiography, Ambulatory, Outcome Assessment, Health Care, Uncertainty
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