Do not systematically request an ECG-Holter in patients with sporadic palpitation if structural heart disease has already been excluded.

Type of practice

Cardiological tests

Topic Area


The 24-hour dynamic ECG according to Holter represents a simple and non-invasive but time consuming diagnostic tool. In clinical practice we often see inappropriate prescriptions. Palpitations are the most common indication (up to 20% of prescriptions). Holter ECG is indicated in the following groups of patients with unexplained palpitations: 1) when the clinical history, physical examination and 12-lead ECG suggest the possibility of an arrhythmia; 2) when a structural cardiac pathology or a channelopathy has been diagnosed, in case of familiarity of sudden death; 3) when the patient needs reassurance and an explanation of her symptoms; 4) when it is necessary to document the symptom-arrhythmia correlation.


1. Steinberg JS, Varma N, Cygankiewicz I, et al. 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry. Heart Rhythm 2017;14:e55-e96.
2. Located ET. New directions for ambulatory monitoring following 2017 HRS-ISHNE expert consensus. J Electrocardiol 2017;50:828-32.
3. Goldberger JJ, Cain ME, Hohnloser SH, et al. American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society scientific statement on noninvasive risk stratification techniques for identifying patients at risk for sudden cardiac death: a scientific statement from the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention. Circulation 2008;118:1497-518
4. Russo V, carbone A, Rago A et al. Elettrocardiogramma dinamico secondo Holter: dalle indicazioni alla refertazione, una guida pratica al corretto utilizzo in cardiologia clinica. G Ital Cardiol 2018; 19 (7): 437-447.



Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.