The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Use of Ambulatory Electrocardiographic (Holter) Monitoring

John P. DiMarco, MD, PhD; and John T. Philbrick, MD
[+] Article, Author, and Disclosure Information

Requests for Reprints:John P. DiMarco, MD, PhD, Box 158, University of Virginia Medical Center, Charlottesville, VA 22908.

Current Author Addresses: Dr. DiMarco:Division of Cardiology, Box 158, University of Virginia Medical Center, Charlottesville, VA 22908. Dr. Philbrick:Division of General Internal Medicine, Box 494, University of Virginia Medical Center, Charlottesville, VA 22908.

© 1990 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1990;113(1):53-68. doi:10.7326/0003-4819-113-1-53
Text Size: A A A

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.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.