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(Circulation. 1999;100:886-893.)
© 1999 American Heart Association, Inc.

ACC/AHA Practice Guidelines

ACC/AHA Guidelines for Ambulatory Electrocardiography: Executive Summary and Recommendations

A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the Guidelines for Ambulatory Electrocardiography) Developed in Collaboration With the North American Society for Pacing and Electrophysiology

Committee Members

Michael H. Crawford, MD, FACC, Chair; Steven J. Bernstein, MD, MPH, FACP; Prakash C. Deedwania, MD, MBBS, FACC; John P. DiMarco, MD, PhD, FACC; Kevin J. Ferrick, MD, FACC; Arthur Garson, Jr, MD, MPH, FACC; Lee A. Green, MD, MPH, FAAFP; H. Leon Greene, MD, FACC; Michael J. Silka, MD, FACC; Peter H. Stone, MD, FACC; Cynthia M. Tracy, MD, FACC

Task Force Members

Raymond J. Gibbons, MD, FACC, Chair; Joseph S. Alpert, MD, FACC; Kim A. Eagle, MD, FACC; Timothy J. Gardner, MD, FACC; Arthur Garson, Jr, MD, MPH, FACC; Gabriel Gregoratos, MD, FACC; Richard O. Russell, MD, FACC; Thomas J. Ryan, MD, FACC; Sidney C. Smith, Jr, MD, FACC

Key Words: ACC/AHA Practice Guidelines • electrocardiography • arrhythmia

	I. Introduction

 
Improvements in solid-state digital technology have enhanced transtelephonic transmission of electrocardiography (ECG) data and increased the accuracy of software-based analysis systems. These advances, in addition to better signal quality and greater computer arrhythmia interpretation capabilities, have opened new potential uses for ambulatory electrocardiography (AECG).

Traditional uses of AECG for arrhythmia detection have expanded as the result of increased use of multichannel and telemetered signals. The clinical application of arrhythmia monitoring to assess drug and device efficacy has been further defined by new studies. The analysis of transient ST-segment deviation remains controversial, but considerably more data are now available, especially about the prognostic value of detecting asymptomatic ischemia. Heart rate variability (HRV) analysis has shown promise for predicting mortality rates in cardiac patients at high risk. Despite these advances, a true automated analysis system has not been perfected and technician/physician participation is still essential.

	II. AECG Equipment

 
The widespread availability and low cost of personal computers and workstations has allowed for the development of extremely sophisticated and automated signal processing algorithms. Current AECG equipment provides for the detection and analysis of arrhythmias and ST-segment deviation as well as more sophisticated analyses of R-R intervals, QRS-T morphology including late potentials, Q-T dispersion, and T-wave alternans.

There are 2 categories of AECG recorders: continuous recorders, typically used for 24 to 48 hours to investigate symptoms and ECG events that are likely to occur within that time frame, and intermittent recorders, which may be used for long periods of time (weeks to months) to provide briefer, intermittent . . . [Full Text of this Article]

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