Don’t perform 24 hour Holter monitoring in patients with effort chest pain who can perform exercise stress test, unless arrhythmias should be investigated.

Type of practice

Cardiological tests

Topic Area


Since during Holter monitoring the amount of stress could not be calibrated, sensitivity and specificity for detecting ischemia in patients with chest pain are low. In these conditions stress test is superior.


1. Crawford MH, Bernstein SJ, Deedwania PC, DiMarco JP, Ferrick KJ, Garson A Jr, Green LA, Greene HL, Silka MJ, Stone PH, Tracy CM, Gibbons RJ, Alpert JS, Eagle KA, Gardner TJ, Gregoratos G, Russell R, Ryan TH, Smith SC. ACC/AHA Guidelines for ambulatory electrocardiography. A report of the Amercian College of Cardiology/American Heart Association task force on practice guidelines (Committee to revise the guidelines for ambulatory electrocardiography) Developed in collaboration with the North American Society for pacing and Electrophysiology. J Am Coll Cardiol. 1999 Sep; 34(3): 912-48.
2. Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). Europace 2006; 8: 746–837.

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.