New directions for ambulatory monitoring following 2017 HRS-ISHNE expert consensus.

The main role of ambulatory electrocardiography (AECG) in clinical practice is to detect and characterize the behavior of cardiac electrical activity during ordinary daily life activities. Because certain rhythm abnormalities may be infrequent and paroxysmal, and may occur only during sleep or in association with mental, emotional, or exercise-induced perturbation in cardiac function, AECG needs to be recorded over a long period of time, originally lasting 24h and now expanding up to several weeks and even to months. New technologies for continuous prolonged AECG monitoring, and new algorithms for automatic arrhythmia detection and wireless data transmission in near real-time, have significantly improved the ECG signals quality for long-term recordings and the diagnostic yield for infrequent cardiac arrhythmias. New wireless electrode systems, such as patches, vests or belts have greatly increased the tolerability, quality and feasibility of prolonged AECG, which is particularly useful for the diagnosis of infrequent symptoms, such as unexplained syncope, palpitations or cryptogenic stroke.