Emerging Role of ambulatory ECG monitoring in the Diagnosis of heart failure with reduced ejection fraction
DOI:
https://doi.org/10.5281/zenodo.22814647Keywords:
ambulatory ECG monitoring, heart failure with reduced ejection fraction, Holter monitoring, arrhythmia detection, heart rate variabilityAbstract
Background: HFrEF carries arrhythmic and autonomic abnormalities, silent atrial fibrillation, nonsustained ventricular tachycardia, excessive ectopic burden, depressed heart rate variability, that a resting ECG cannot capture.
Objective: This review synthesizes evidence on ambulatory ECG monitoring, spanning Holter recording, patch monitors, and implantable loop recorders, as a diagnostic and risk-stratification tool in HFrEF.
Methods: We synthesized cohort studies, randomized trials, guideline documents, and device-validation studies on continuous rhythm surveillance, arrhythmia burden, autonomic indices, and clinical application in reduced ejection fraction heart failure.
Findings: Monitoring duration is the dominant determinant of yield; extended patch and implantable recorders detect substantially more fibrillation and ectopy than a single 24-hour study, ectopic burden and heart rate variability independently track with dysfunction and mortality, and society guidelines embed ambulatory ECG across diagnosis, risk stratification, and device candidacy.
Conclusions: Ambulatory ECG monitoring is now a central, guideline-endorsed component of the HFrEF diagnostic pathway, its value maximized when duration matches the clinical question and findings are read alongside ejection fraction and clinical status.
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