Seven-Day Holter Monitoring Substantially Improves Detection of Low-Burden Atrial Fibrillation　― Results From a Large Japanese Multicenter Cohort ―

Q: What are the key findings of this study?

Seven-day Holter monitoring substantially improved the detection of low-burden (<10%) paroxysmal atrial fibrillation, yielding a 2.6-fold increase compared to standard 24-hour monitoring.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation (n=25817). Intervention: 7-day Holter monitoring vs. 24-hour Holter monitoring. Primary outcome: Detection of paroxysmal atrial fibrillation with <10% burden (2.57-fold increase).

Y Inoue; K Nakatsuji; Koichiro Kumagai; Tadashi Hoshiyama; Kenichi Tsujita; Takahisa Noma; Yoshihiro Kokubo; Masatoshi Koga; Naoki Mochizuki; Hisao Ogawa; Kengo Kusano

doi:10.1253/circj.cj-25-1126

March 5, 2026Circulation JournalOpen Access

Seven-Day Holter Monitoring Substantially Improves Detection of Low-Burden Atrial Fibrillation　― Results From a Large Japanese Multicenter Cohort ―

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Key result

Seven-day Holter monitoring yields a ~2.6-fold increase in detecting low-burden paroxysmal AF vs. 24-hour monitoring.

2.57-fold increase
n=25,817

Why the study?

AF burden and longest duration are important predictors of heart failure and embolism, but burden-specific detection rates on 7-day Holter ECG remain unclear.

Does 7-day Holter monitoring improve the detection of low-burden atrial fibrillation compared to 24-hour monitoring in patients undergoing ambulatory ECG?

Key Points

To evaluate how atrial fibrillation burden influences the timing and diagnostic yield of arrhythmia detection during 7-day Holter monitoring and assess its relationship with episode duration.
Multicenter cohort study evaluating 25,817 eligible 7-day patch-type Holter recordings (from 36,363 individuals across 1,653 medical centers in Japan) after excluding recordings <100 h (n=7,134) and those with >20% artifacts (n=3,412).
Paroxysmal atrial fibrillation (AF) was defined as an irregular rhythm lasting ≥30 s without P waves, with AF burden calculated as the percentage of total monitoring time in AF (<10% defined as low burden).
Among 2,289 paroxysmal AF cases, low-burden AF (<10%) accounted for 66.3%, and 7-day monitoring produced a 2.6-fold increase (2.57-fold) in paroxysmal AF detection compared with 24-hour monitoring.
Only 45% (1,033) of paroxysmal AF episodes were detected within the first 24 hours, whereas 55% (1,256) were detected thereafter; median time to first detection was 37 h (IQR 11–83 h) in the <10% burden subgroup versus 13 h (IQR 1–40 h) in the ≥10% subgroup (β=23.8, 95% CI: 20.1–27.6, P<0.001).
AF burden demonstrated a strong positive correlation with the longest paroxysmal AF duration (Spearman's r=0.79, P<0.001).

Study Design

Type

Cohort (n=25,817)

Multicenter

Yes

Structured PICO

Does 7-day Holter monitoring improve the detection of low-burden atrial fibrillation compared to 24-hour monitoring in patients undergoing ambulatory ECG?

P

Population

25,817 individuals in Japan who underwent 7-day patch-type Holter monitoring with eligible recordings of at least 100 hours.

E

Exposure

7-day patch-type Holter monitoring

C

Comparator

24-hour monitoring (assessed via the first 24 hours of the 7-day recording)

O

Outcome

Detection of paroxysmal atrial fibrillation across different AF burden categoriessurrogate

Main Result

Effect estimate: 2.57-fold increase

7-day Holter monitoring substantially increases the detection yield of low-burden paroxysmal atrial fibrillation compared to standard 24-hour monitoring.

Limitations

Potential selection bias due to physician-determined indications for 7-day Holter monitoring
Selection bias due to physician-determined indications for 7-day Holter monitoring

Ask about this paper

Answers are grounded in this paper and cite their sources.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

May support 7-day Holter for low-burden AF detection in practice; leaves open whether this improves outcomes or warrants routine use.

Abstract

BACKGROUND: Atrial fibrillation (AF) burden and longest duration are important predictors of heart failure and embolism. However, burden-specific detection rates on 7-day Holter ECG remain unclear. METHODS AND RESULTS: Among 25,817 recordings, 2,289 cases of paroxysmal AF and 571 cases of persistent AF were identified. Low-burden AF was common, and 7-day monitoring substantially improved detection, particularly for AF burden <10% (2.6-fold increase vs. 24-h). AF burden correlated with the longest duration (r=0.79). CONCLUSIONS: 7-day Holter monitoring improved low-burden AF detection and confirmed a strong correlation between AF burden and longest duration.

Cite This Study

Inoue et al. (2026) conducted a cohort in Atrial fibrillation (n=25,817). 7-day Holter monitoring vs. 24-hour Holter monitoring was evaluated on Detection of paroxysmal atrial fibrillation with <10% burden (2.57-fold increase). Seven-day Holter monitoring substantially improved the detection of low-burden (<10%) paroxysmal atrial fibrillation, yielding a 2.6-fold increase compared to standard 24-hour monitoring.

synapsesocial.com/papers/69ad12afe7e9681137aa8a90 https://doi.org/10.1253/circj.cj-25-1126

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Seven-Day Holter Monitoring Substantially Improves Detection of Low-Burden Atrial Fibrillation　― Results From a Large Japanese Multicenter Cohort ―

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Discussion

Implication

Abstract

Cite This Study

Seven-Day Holter Monitoring Substantially Improves Detection of Low-Burden Atrial Fibrillation　― Results From a Large Japanese Multicenter Cohort ―

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Discussion

Implication

Abstract

Cite This Study

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Seven-Day Holter Monitoring Substantially Improves Detection of Low-Burden Atrial Fibrillation ― Results From a Large Japanese Multicenter Cohort ―

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Discussion

Implication

Abstract

Cite This Study

Seven-Day Holter Monitoring Substantially Improves Detection of Low-Burden Atrial Fibrillation ― Results From a Large Japanese Multicenter Cohort ―

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Discussion

Implication

Abstract

Cite This Study

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Seven-Day Holter Monitoring Substantially Improves Detection of Low-Burden Atrial Fibrillation　― Results From a Large Japanese Multicenter Cohort ―

Seven-Day Holter Monitoring Substantially Improves Detection of Low-Burden Atrial Fibrillation　― Results From a Large Japanese Multicenter Cohort ―