Cited by 177ECG Monitoring and AnalysisCardiac electrophysiology and arrhythmiasHeart Rate Variability and Autonomic Control

The DOI matches its Crossref record; 134 of the 134 references it cites were found in a registry or an index.

Use of Ambulatory Electrocardiographic (Holter) Monitoring

DiMarco, John P., Philbrick, John T.·1990·Annals of Internal Medicine

DOI 10.7326/0003-4819-113-1-53

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Abstract

PURPOSE: To evaluate the clinical efficacy of ambulatory electrocardiographic (ECG) monitoring and to develop guidelines for its use in clinical practice. DATA IDENTIFICATION: Studies reported since January 1978 were identified both through computer searches using Index Medicus and extensive manual searching of bibliographies of identified articles. STUDY SELECTION: Only studies that fulfilled methodologic criteria designed to limit bias were reviewed. DATA EXTRACTION: Information describing population and study results was assessed in four major categories (variability, diagnosis, prognosis, and therapy guidance) for both arrhythmia monitoring and ST-segment analysis. RESULTS OF DATA ANALYSIS: The day-to-day variability of arrhythmia and myocardial ischemia detected by ambulatory ECG monitoring may be considerable in an individual patient. Caution must therefore be used in interpreting serial tests. Ambulatory ECG monitoring with diary correlation permits documentation of cardiac arrhythmias causing symptoms, but the diagnostic yield is low unless symptoms are frequent. Such monitoring can provide information about prognosis in patients after acute myocardial infarction. The amount of prognostic information obtained is modest and is outweighed by other measures. There is insufficient information to make conclusions about such monitoring and prognosis in other conditions. Serial ambulatory ECG monitoring may be used to assess the effect of an antiarrhythmic drug in patients with frequent and reproducible ventricular ectopy. The effect of arrhythmia suppression on survival is uncertain. Because of its low sensitivity and specificity, analysis of ST-segment changes during ambulatory ECG monitoring is inaccurate in establishing or excluding the presence of coronary disease. Although anti-ischemic interventions reduce the frequency and duration of ST-segment changes on monitoring, there are no data on the utility of using reduction or elimination of the changes as the endpoint of therapy. CONCLUSIONS: Ambulatory ECG monitoring can provide diagnostic, prognostic, and therapeutic information in many situations, but similar information often may be better obtained in other ways.

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Authors: DiMarco, J. P., & Philbrick, J. T.
Affiliations: University of Virginia Medical Center (US)
Corresponding author: DiMarco, John P.
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 1990-07-01
Volume: 113
Issue: 1
Pages: 53-68
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/0003-4819-113-1-53
OpenAlex: W1979276457
Cited by: 177
References: 134
Citations by year: 2026: 3 · 2025: 8 · 2024: 8 · 2023: 4 · 2022: 9 · 2021: 9 · 2020: 2 · 2019: 4 · 2018: 4 · 2017: 2 · 2016: 2 · 2014: 6 · 2013: 8 · 2012: 1
FWCI: 0.73
Type: journal article
Language: en
Open access: closed
Licence: www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations: Annals of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords: Holter monitoring, arrhythmia monitoring, myocardial ischemia, ST-segment changes, antiarrhythmic drugs, ventricular ectopy, serial ECG monitoring, anti-ischemic therapy
MeSH terms: Arrhythmias, Cardiac, Coronary Disease, Humans, Predictive Value of Tests, Prognosis, Reproducibility of Results, Electrocardiography, Ambulatory

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