S D Med. 2026 May;79(suppl 5):s20-s22.
ABSTRACT
BACKGROUND: Prolonged ambulatory ECG monitoring is hypothesized to improve detection of paroxysmal arrhythmias compared with standard 24-hour Holter monitoring. This systematic review and meta-analysis evaluated whether 14-day single-lead adhesive ECG patch monitoring enhances detection of clinically significant arrhythmias versus conventional Holter monitoring.
METHODS: Following PRISMA guidelines, PubMed, Scopus, and Embase were searched. Studies comparing 14-day ECG patch with Holter monitoring (primarily 24-72 hours) in ambulatory adults with suspected paroxysmal arrhythmia were included. Primary outcomes were detection rates of atrial fibrillation/flutter (AF), major arrhythmias, atrioventricular block, sinus pause, ventricular tachycardia, and supraventricular tachycardia. Risk of bias was assessed using ROBINS-I and RoB 2. Risk ratios (RR) with 95% confidence intervals were pooled using random-effects models in Review Manager (RevMan). Heterogeneity was evaluated with I² statistics, and sensitivity/subgroup analyses performed. The protocol was registered on PROSPERO (CRD420251248305).
RESULTS: Six studies met inclusion criteria. Primary analyses showed substantial heterogeneity for most outcomes. No significant differences were observed for AF (RR 0.43, 95% CI 0.05-3.51), major arrhythmias (RR 0.41, 95% CI 0.16-1.01), atrioventricular block (RR 1.10, 95% CI 0.42-2.90), sinus pause (RR 1.09, 95% CI 0.47-2.49), ventricular tachycardia (RR 0.62, 95% CI 0.03-11.98), or supraventricular tachycardia (RR 0.39, 95% CI 0.11-1.44). Sensitivity analyses excluding one influential study often resolved heterogeneity and shifted results, favoring Holter monitoring for AF, major arrhythmias, and ventricular tachycardia, or the 14-day patch for supraventricular tachycardia. Subgroup analysis by patient type showed no significant interaction.
CONCLUSION: Fourteen-day ECG patch monitoring showed no overall statistically significant superiority over 24-hour Holter monitoring for detecting clinically actionable arrhythmias. High heterogeneity and strong sensitivity to individual studies reflecting variability in devices, populations, and designs shows key limitations in current evidence. Larger, high-quality, standardized randomized trials are essential to clarify if extended patch monitoring offers true diagnostic advantages.
PMID:42525983
