Recent advances in the understanding of ambulatory electrocardiography

The recent expanded interest in the identification of factors predicting patients at risk for sudden death from coronary heart disease has led to an increased knowledge of the usefulness of ambulatory ECG monitoring. At the origin of this interest are a number of early epidemiologic studies suggesting that ventricular ectopy is an easily identifiable predictor of coronary patietns at risk for subsequent sudden death. This article focuses on numerous aspects of ambulatory ECG monitoring, emphasizing the detection of ventricular ectopy primarily in the setting of coronary heart disease. The additional benefits of ambulatory ECG monitoring compared to standard 12-lead ECG recordings in detecting ventricular premature beats (VPBs) are also reviewed. Further, the relative sensitivity of ambulatory ECG monitoring of comparison to maximal treadmill exercise testing in detecting VPBs is delineated. How VPB prevalence and complexity relate to parameters of ventricular function in patients with coronary heart disease are analyzed. Attention is directed to the reproducibility and variability of ambulatory ECG monitoring in detecting VPBs. A concise review of applications of ambulatory ECG monitoring, emphasizing coronary heart disease, is presented.