2017 ISHNE-HRS Expert Consensus Statement on Ambulatory ECG and External Cardiac Monitoring/Telemetry

Ambulatory ECG (AECG) telemetry is typically used to evaluate symptoms such as syncope, dizziness, chest pain, palpitations, or shortness of breath, which may correlate with intermittent cardiac arrhythmias. AECG is also used to evaluate patient response to initiation, revision, or discontinuation of arrhythmic drug therapy and to assess prognosis in specific clinical contexts. The objectives of this ISHNE/HRS Expert Consensus Statement are as follows:

• To review how contemporary AECG devices acquire and process ECG signals and how they should be interpreted.
• To review appropriate utilization of these devices in the management of cardiovascular disease.
• To promote standards that will improve the accuracy and appropriate use of the AECG in clinical practice.

Accurate and timely diagnosis of arrhythmias is crucial to direct therapies that can make an important impact on patient care and health care utilization. The rhythm information derived from the large spectrum of AECG recording systems can often lead to appropriate and patient-specific medical and interventional management. The details in this document provide background and framework from which to apply AECG techniques in clinical practice, as well as clinical research. AECG is very commonly used in a variety of clinical contexts, for a variety of clinical purposes, and involves a variety of clinical personnel. There needs to be an understanding of the strengths and limitations of the AECG per se, and also of the specifically implemented technique, in order to optimize the impact that these results have on patient care. The writing group recognizes that technical details of the processing and recording of AECGs may be unfamiliar to some clinicians. Accordingly, a major purpose of this document is to provide clinicians with insight concerning current technology and its implications for clinical interpretation. Moreover, evolving technologies permit integration of cardiac data with other monitored variables, extending traditional applications.