Detection of arrhythmias by 24-hour holter monitoring versus 14-day continuous electrocardiogram patch: a systematic review and meta-analysis

Introduction Twenty-four-hour ambulatory Holter monitoring has long been considered the gold standard for cardiac arrhythmia diagnosis. However, its limited monitoring window frequently restricts the detection of paroxysmal, intermittent, or infrequent arrhythmic events with significant prognostic and therapeutic implications. Fourteen-day continuous ECG patch devices have emerged as an advanced alternative, offering prolonged cardiac surveillance with improved patient comfort, wearability, and adherence — potentially translating into superior diagnostic yields across a broad spectrum of arrhythmia types. Methods PubMed, Embase, and the Cochrane Library were systematically searched for studies enrolling adults (>18 years) that directly compared 24-hour Holter monitoring with 14-day continuous ECG patch devices for the detection of clinically relevant arrhythmias, including atrial fibrillation and flutter, supraventricular and ventricular tachycardia, atrioventricular block, and significant pauses. Outcomes were expressed as risk difference (RD) with 95% confidence intervals (CI); statistical heterogeneity was assessed using the I² statistic. All analyses were performed in R (version 4.4.1). Results Five studies comprising a total of 1,255 patients were included. Continuous ECG patch monitoring demonstrated significant superiority over 24-hour Holter monitoring in detecting any significant arrhythmia (RD 36.1%; 95% CI 21.7%–50.5%; p<0.001). This superiority was consistent for atrial fibrillation and flutter (RD 6.3%; 95% CI 3.4%–9.2%; p<0.001) and supraventricular tachycardia (RD 38.1%; 95% CI 19.7%–56.5%; p<0.001). No statistically significant difference was observed for ventricular tachycardia detection (RD 4.7%; 95% CI −1.2%–10.6%; p=0.118), suggesting that the diagnostic advantage of extended monitoring may be arrhythmia-type dependent. Conclusions The 14-day continuous ECG patch demonstrated consistent and clinically meaningful superiority over 24-hour Holter monitoring for the detection of atrial fibrillation, flutter, and supraventricular tachycardia, though this benefit was not statistically significant for ventricular tachycardia. In clinical practice, transitioning to prolonged ambulatory monitoring strategies may enable earlier identification of clinically significant arrhythmias and facilitate timely, targeted therapeutic interventions. The substantial heterogeneity observed in overall arrhythmia detection suggests that diagnostic yield may vary according to patient clinical profile and comorbidity burden, underscoring the need for further well-designed studies to identify the subgroups deriving the greatest diagnostic and clinical benefit from extended ECG monitoring technology.ghlighting the need for further studies to define subgroups deriving the greatest benefit.