Ambulatory Electrocardiogram ECG

Authored by , Reviewed by Dr Helen Huins | Last edited | Meets Patient’s editorial guidelines

Ambulatory electrocardiogram monitors your heart when you are doing your normal activities. It helps to detect abnormal heart rates and rhythms (arrhythmias).

The arrangements, and the way tests are performed, may vary between different hospitals. Always follow the instructions given by your doctor or local hospital.

The ECG test records the electrical activity of your heart when you are walking about (ambulatory) and doing your normal activities. Small metal electrodes are stuck on to your chest. Wires from the electrodes are connected to a small lightweight recorder (often called a Holter monitor). The recorder is attached to a belt which you wear around your waist. (It is like wearing an mp3 player.) The electrical activity is usually recorded for 24-48 hours.

Your doctor may advise you have this test if he or she suspects that you are having bouts of an abnormal heart rate or rhythm (arrhythmia). For example, if you have the feeling of a 'thumping heart' (palpitations) or episodes of dizziness. Some arrhythmias 'come and go' and may only last seconds or minutes. They may never be found when you are examined by a doctor. So, the test may detect an arrhythmia.

It takes about 10 minutes for the electrodes and recorder to be fitted. You then go and do what you normally do over the next 24-48 hours. You wear the recorder when asleep in bed too. (However, you should not have a bath or shower, as the recorder should not get wet.)

You will be given a diary to record the times when you develop any symptoms - such as the feeling of a 'thumping heart' (palpitations). The ECG tracing is analysed at the end of the test. But, any times you record when you had symptoms will be most carefully analysed to see if you had an abnormal heart rate or rhythm (arrhythmia) to account for the symptoms. A doctor may ask you to do some activities which have previously brought on symptoms, to try to provoke the same symptoms.

There are some variations in the equipment that may be used:

  • On some recorders, you press a button to mark the time whenever symptoms occur.
  • Some recorders activate automatically only if your heart rate or rhythm is abnormal.
  • With some recorders you send the ECG tracing for analysis down the phone line.
  • Some recorders are worn for longer periods. These are called 'event' monitors. They record only when you switch them on during an 'event' such as a bout of palpitations.

Further reading and references