Ambulatory electrocardiography devices

Holter monitor3–12 leads attached by wires
Data are uploaded after recording is complete
24–48 hours continuouslyPalpitations, syncope, or presyncope when symptoms occur nearly daily
Silent arrhythmia that occurs frequently or to assess for arrhythmia recurrence after therapy
Continuous recording
Full disclosure
Up to 12 leads
Physician familiarity
Short duration
Post hoc analysis
Uses wires and gel electrodes
Post-event recorderLeadless held to the chest during symptoms
Real-time transmission of data for analysis
Up to 30 days intermittentlyInfrequent symptoms (eg, palpitations) that are not debilitatingExtended observation
Real-time data transmission
Records only selected sequences
Requires patient activation
External loop recorder3–12 leads attached by wires
Records when triggered by patient or arrhythmia
Up to 30 days; continuous observation and intermittent recordingInfrequent symptoms or suspected infrequent silent arrhythmiaExtended recording
Automated arrhythmia analysis
Multichannel acquisition
Backwards memory
Records only selected sequences
Uses wires and gel electrodes
Implantable loop recorderImplanted subcutaneously in the left parasternal regionUp to 3 years; continuous observation and intermittent recordingVery infrequent symptoms
Suspected paroxysmal atrial fibrillation in cryptogenic stroke
Very long observation
Automated arrhythmia analysis
Records only selected sequences
Requires surgical insertion
High cost
Mobile cardiac telemetry3 leads attached by wires
Communicates with portable monitor and real-time transmission for analysis
1–4 weeks continuouslySuspected high-risk arrhythmia (eg, ventricular tachycardia) that can be identified and addressed in real time
After starting new antiarrhythmic drug
Continuous and extended recording
Real-time rhythm analysis and response
Requires significant manpower for monitoring
High up-front cost for device
Patch monitorAffixed to the left pectoral region
Some have real-time telemetry, others require later data analysis
2–4 weeks continuouslyModerate frequency symptoms or suspected low-risk asymptomatic arrhythmiaContinuous recording
Full disclosure
Ergonomic design increases patient adherence
Single channel
Needs post hoc analysis
Smart- tech ECGFingers are placed on an external sensor
Generates a single- lead electrocardiogram on the phone or watch screen
30 seconds intermittentlyIntermittent, low-risk, nondebilitating symptoms (eg, palpitations in low-risk clinical context)Widely available
Automated rhythm analysis for atrial fibrillation
Single channel
No continuous observation
Requires patient activation
  • $ = < $150; $$ = $150–$500; $$$ = $500–$1,000; $$$$ = > $1,000