Veterinary ambulatory ECG monitoring
Continuous ECG recording during normal daily life to investigate intermittent rhythm abnormalities, relate clinical episodes to heart rhythm and support ongoing cardiac management.
Led by Fabrizio Tucciarone, DVM MRCVS GPcert(SAM) MSc PgCert (Endo) CertAVP
A longer view of heart rhythm
A standard ECG is valuable, but it represents only a brief period in the clinic. Holter monitoring records every heartbeat over 24 or 48 hours while the patient follows a representative routine at home.
The resulting trace can show whether an arrhythmia is present, how frequently it occurs and whether it coincides with exercise, sleep, medication or a clinical episode recorded in the owner diary.
Clinical questions
The recording is planned around a defined referral question. These examples describe common reasons to consider ambulatory ECG monitoring.
Collapse · fainting · episodic weakness
Continuous ECG recording can help determine whether a period of collapse, syncope, weakness or unusual behaviour coincides with a clinically important rhythm disturbance during normal daily activity.
Irregular rhythm · pauses · episodic tachycardia
A brief in-clinic ECG records only a small window of time. Holter monitoring increases the opportunity to capture rhythm abnormalities that occur unpredictably or only under particular circumstances.
Frequency · pattern · complexity
The recording can help describe the number, timing and pattern of premature or ectopic beats over 24 or 48 hours, providing more context than an isolated ECG finding.
Known diagnosis · longitudinal assessment
Repeat ambulatory ECG monitoring may be useful when a rhythm abnormality has already been identified and the referring vet needs an objective comparison with a previous recording or clinical assessment.
Anti-arrhythmic medication · response · safety
Holter monitoring can contribute to assessment of rhythm control after medication is started or adjusted. Results are interpreted alongside the patient’s signs, examination and wider cardiac plan.
Exercise · rest · sleep · reported events
An owner diary allows activity, sleep, exercise, medication and any observed episodes to be compared with the ECG timeline, helping the report address the original clinical question.
The owner diary
Owners are asked to note sleep, exercise, meals, medication and the precise time of any collapse, weakness, coughing, restlessness or other relevant event. Accurate timings allow the reported signs to be compared with the ECG trace.
The monitor should remain securely fitted and dry throughout the recording. A normal but safe routine usually produces the most representative information, and individual instructions are provided when the device is fitted.
How referral works
Holter monitoring is arranged through your usual veterinary practice. Please speak to your own vet first if your pet has experienced collapse, weakness or a possible heart-rhythm problem.
The practice shares the referral question, history, current medication, relevant ECGs and other cardiac results.
Small areas are clipped, the electrodes and recorder are fitted, and a protective vest helps keep the equipment secure.
The patient returns home for 24 or 48 hours while the owner keeps the device dry and completes the activity and event diary.
The equipment is returned, the trace is processed through the agreed interpretation pathway and the report is sent to the referring vet.
Common questions
If you are unsure whether ambulatory ECG monitoring is the right next step, send the clinical question and available cardiac records for review.
No. The patient’s primary veterinary practice arranges the referral and provides the relevant clinical history, ECGs, medication and referral question.
The most useful duration depends on the frequency of the suspected events and the clinical question. A 48-hour recording may improve the chance of capturing infrequent signs, but the duration is agreed for each patient.
Small areas of hair are usually clipped so the ECG electrodes can maintain good skin contact. The device and protective vest are fitted securely, and any medication instructions are agreed with the referring practice.
Normal, representative activity is generally helpful, but the monitor must remain secure and dry. Owners receive instructions about exercise, sleeping, medication, the event diary and what to do if an electrode or the vest moves.
No. Holter monitoring assesses the heart rhythm over time; it does not assess heart structure in the way echocardiography does. The two tests answer different questions and may be used together when appropriate.
No. A patient that is actively collapsing, severely weak, breathless or otherwise unstable should follow the referring practice’s emergency pathway.
Discuss a case
Share the case details and we’ll help identify the most useful next step.