AbstractBackgroundDetecting high‐risk arrhythmia is important in diagnosing patients with palpitations. We compared the diagnostic accuracies of 7‐day patch‐type electrocardiographic (ECG) monitoring and 24‐h Holter monitoring for detecting significant arrhythmias in patients with palpitations.MethodsThis was a single‐center prospective trial with 58 participants who presented with palpitations, chest pain or syncope. Outcomes were defined as the detection of any one of six arrhythmias, including supraventricular tachycardia (SVT), atrial fibrillation or atrial flutter lasting more than 30 s, pauses of more than 3 s, high‐degree atrioventricular block, ventricular tachycardia (VT) >3 beats, or polymorphic VT/ventricular fibrillation. The McNemar test for paired proportions was used to compare arrhythmia detection rates.ResultsThe overall arrhythmia detection rate was higher with 7‐day ECG patch monitoring than with 24‐h Holter monitoring (34.5% vs. 19.0%,p= .008). Compared with the use of 24‐h Holter monitors, the use of 7‐day ECG patch monitors was associated with higher detection of SVT (29.3% vs. 13.8%,p= .042). No serious adverse skin reactions were reported among the ECG patch‐monitored participants.ConclusionsThe results suggest that a 7‐day patch‐type continuous ECG monitor is more effective for the detection of supraventricular tachycardia than is a 24‐h Holter monitor. However, the clinical significance of device detected arrhythmia should be consolidated.