Drawing on data from more than 1.1 million patients who used iRhythm’s Zio® long-term continuous monitoring (LTCM) ECG devices, these studies demonstrate that short-term (24–48-hour) monitoring, such as with Holter devices, fails to detect a significant proportion of actionable arrhythmias—even in patients reporting "daily symptoms”—and that Symptom–Rhythm Correlation (SRC) is notably low for most arrhythmias, underscoring that selection of monitoring duration based on the frequency of symptoms alone can lead to undetected (missed) actionable1 arrhythmias.
Serious Arrhythmias Frequently Not Correlated with Symptoms: Ventricular tachycardia, AV block, and significant pauses were frequently detected by Zio LTCM without patient-reported symptoms, suggesting that selection of monitor duration should not be based on symptom frequency alone, and that long-term continuous monitoring may offer advantages over other monitoring types with shorter duration or those which rely on patient triggered events to initiate recording.
Implications for Clinical Care and Payer Policy While 24–48-hour Holter monitoring is widely used in current clinical practice and historically supported by payer policies—especially for patients reporting daily symptoms—these new findings indicate that 64% of daily-symptom patients with actionable arrhythmias remain undetected following the first 48 hours of monitoring, which could lead to missed diagnoses and delayed care.
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