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Ambulatory ECG Monitoring

Table of Contents

  • Introduction
  • What is ambulatory ECG monitoring?
  • Study duration types
  • Clinical indications
  • How to request an ambulatory ECG
  • Fitting an ambulatory ECG (Holter) device
  • Procedure steps
  • Patient advice and safety netting
  • References
  • Test Yourself

Introduction

  • Ambulatory ECG monitoring records electrical heart activity over a prolonged period during normal activities including rest and sleep.
  • Different from resting ECG which records for ~10 seconds.
  • Uses a small, battery-powered wearable device with 2-3 leads (up to 12 in some devices), often called a Holter monitor.

What is ambulatory ECG monitoring?

  • Enables detection of intermittent arrhythmias not caught on resting ECG.
  • Records rate, rhythm and other electrical activity for extended periods.

Study duration types

  • Common durations: 24 hours, 72 hours, 7 days.
  • Can extend up to 14 days if needed.
  • Longer duration increases likelihood of detecting arrhythmias.

Clinical indications

  • Investigating intermittent symptoms like:
  • Syncope (transient loss of consciousness)
  • Chest pain
  • Palpitations
  • Dizziness
  • Shortness of breath
  • Monitoring known arrhythmias and pacemaker function.
  • Atrial fibrillation diagnosis and post-ablation monitoring.

How to request an ambulatory ECG

Include in request:
- Patient details: DOB, hospital/ID number, address
- Indication, e.g., "palpitations"
- Relevant medical and medication history
- Recent 12-lead resting ECG

Fitting an ambulatory ECG (Holter) device

Equipment needed

  • Ambulatory ECG device (fully charged, programmed)
  • Self-adhesive ECG electrodes and leads
  • Razor (for chest hair removal if needed)
  • Antibacterial wipes (for skin prep)
  • Patient diary (to record symptoms and activities)

Procedure overview

  • Introduce yourself and explain the procedure clearly to the patient.
  • Obtain consent; offer chaperone for female patients if desired.
  • Expose and prepare the chest: clean with antibacterial wipe, shave hair if required.
  • Attach electrodes according to device instructions; connect device.
  • Turn on device as per manufacturer instructions.
  • Advise patient to keep diary, avoid water and interference from electrical devices.
  • Instruct on safety netting: contact emergency services for red flag symptoms.
  • Document start time and device ID in patient notes.

Patient advice and safety netting

  • Device should be worn continuously for the prescribed period.
  • Keep device dry and away from electrical interference.
  • Record symptoms and activities in diary.
  • Contact emergency services if experiencing severe symptoms.
  • Return device and diary after monitoring period.

References

  • NICE Guidelines: Diagnosis of atrial fibrillation
  • Heuser J. Holter Monitoring
  • Bruce Blaus. Holter Monitor (CC BY-SA 4.0)

Test Yourself

  • [Link to clinical questions on ambulatory ECG monitoring]

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