Concierge cardiac electrophysiology · London
Continuous ambulatory ECG monitoring, 14-day patch and implantable loop recorders — capturing what a 24-hour Holter misses.
Continuous ECG monitoring extends beyond the 24-hour Holter to 14-day patches (Zio) and implantable loop recorders that record for up to 3 years. The modern approach for infrequent palpitations, cryptogenic stroke and rare high-risk arrhythmias.
Why patients choose us
- 01
The right hands
We route you to a consultant cardiac electrophysiologist — the specialist who chooses the modality, reads the trace and owns the plan.
- 02
Beyond the 24-hour Holter
14-day patch monitors and implantable loop recorders capture what a single-day Holter misses — the rare, symptomatic beat.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
The problem
A 24-hour Holter often misses the beat that matters.
Paroxysmal atrial fibrillation, short pauses and rare high-risk arrhythmias rarely oblige a single day’s recording. Continuous monitoring extends the window from 24 hours to two weeks — or three years, if the ILR is the right tool.
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Palpitations once a fortnight?
A 14-day patch is the right first-line tool — the yield is three to four times a Holter.
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Cryptogenic stroke work-up?
Guidelines back ILR insertion — occult AF detection changes anticoagulation and recurrence risk.
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Recurrent unexplained syncope?
An ILR with up to three years of battery can capture what standard tests routinely miss.
The journey
From consultation to report — what happens, in order.
A consultant cardiac electrophysiologist owns the pathway from the first appointment to the final report.
Phase 1 · Before the recording
Consultation and modality choice
Phase 2 · On the day
Device fitted, diary started
Phase 3 · After
Wireless upload and report
- 01
Before
Cardiology consultation
A consultant electrophysiologist reviews your history, symptoms and prior ECGs to decide whether continuous monitoring is the right step.
- 02
Before
Choose modality
A 14-day skin patch (Zio, Nox) for infrequent palpitations, or an implantable loop recorder (ILR) for rare high-risk arrhythmias and cryptogenic stroke work-up.
- 03
On the day
Skin preparation and patch application
The skin is cleaned and the small, waterproof adhesive patch is placed on the left chest. ILR insertion is a short local-anaesthetic procedure.
- 04
On the day
Diary of symptoms
You log palpitations, dizziness or blackouts as they happen — the trigger button on the device time-stamps the trace.
- 05
After
Wireless data upload
Modern patches upload continuously by mobile connection; ILRs transmit nightly via a bedside hub — no clinic visits between recordings.
- 06
After
ILR follow-up remote monitoring
For implantable loop recorders, the electrophysiology team reviews transmissions and flags episodes for up to three years.
- 07
After
Cardiology report and structured plan
A consultant electrophysiologist report with symptom-rhythm correlation and a concrete next step — rate, rhythm, ablation, pacemaker or ICD.
Typical recording: 7–14 days for a patch, up to 3 years for an implantable loop recorder.
What it detects
When continuous monitoring is the right test.
Continuous monitoring answers a specific question — what rhythm you were in during a symptom, or whether occult arrhythmias explain a stroke or syncope.
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Paroxysmal atrial fibrillation
The commonest yield of extended monitoring — brief, self-terminating AF that a 24-hour Holter routinely misses.
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Sinus pauses
Prolonged pauses in the sinus rhythm — a marker of sinus node dysfunction that can cause dizziness or syncope.
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Non-sustained ventricular tachycardia
Short runs of ventricular tachycardia — a risk marker requiring cardiology assessment.
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Complete heart block episodes
Intermittent AV conduction block — often the cause of unexplained syncope and a common pacemaker indication.
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Symptom-rhythm correlation
The core purpose of extended monitoring — matching a logged symptom to the rhythm at that exact second.
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AF detection in cryptogenic stroke
The ILR indication with the clearest evidence base — occult AF found after a stroke of unknown cause changes anticoagulation.
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Rare high-risk arrhythmias
Episodes so infrequent that only weeks-to-years of monitoring will capture them.
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Red flag: sustained VT or long pause with syncope — urgent cardiology admission
Do not wait for the outpatient report. Call 999 or attend A&E immediately.
Monitor types
Not all continuous monitors are the same.
What each device on your referral is actually for.
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14-day skin patch (Zio, Nox)
A small, waterproof adhesive patch on the left chest — the standard first-line extended monitor for infrequent palpitations.
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7-day patch monitor
A shorter patch course when weekly symptoms are expected — a middle ground between Holter and full 14-day recording.
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Implantable loop recorder (ILR)
A paper-clip-sized subcutaneous device with up to 3-year battery life — for cryptogenic stroke and rare high-risk arrhythmias.
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External loop recorder (30 days)
A wearable loop recorder for a full month of monitoring when the patch window is likely to miss the event.
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Mobile cardiac telemetry
Real-time transmission with clinician review of significant arrhythmias — used when immediate detection matters.
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Post-ablation surveillance
Extended monitoring after AF ablation to quantify residual arrhythmia burden.
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Cryptogenic stroke ILR work-up
ILR insertion after a stroke of unknown cause to detect occult atrial fibrillation.
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Syncope work-up
ILR for recurrent unexplained syncope when standard investigations are non-diagnostic.
Our vetted London network
A small panel of electrophysiology programmes, we picked them.
Partners across central, north, west and south London. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every clinic in our network.
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Consultant cardiac electrophysiologists reading every trace
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Certified device programmes (Zio, Reveal LINQ, BIOMONITOR, Confirm Rx)
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Structured report with symptom-rhythm correlation and a concrete plan
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Onward ablation, pacemaker or ICD pathway if the trace requires it
Key facts and safety
What to know before you start.
Continuous monitoring is exceptionally safe — the practical points are the modality choice, the diary discipline, and when to escalate.
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Skin patch is small and waterproof
The Zio and Nox patches are lightweight, hypoallergenic and rated for showering — daily life continues as normal.
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Higher diagnostic yield than Holter
14-day continuous recording detects three to four times more clinically significant arrhythmias than a single 24-hour Holter.
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ILR is a paper-clip-sized device
The implantable loop recorder is inserted under the skin of the left chest under local anaesthetic — a five-minute outpatient procedure.
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Modern wireless data upload
No clinic visits between recordings — patches and ILRs transmit to the reading centre automatically.
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ILR battery lasts up to 3 years
Continuous rhythm surveillance for years — the right tool for episodes that occur every few months.
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Skin irritation is uncommon
A minority of patients develop mild adhesive irritation — hypoallergenic replacements are available if needed.
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Sustained VT is a 999 call
If you feel sustained fast palpitations with syncope, chest pain or breathlessness, do not wait for the report — call 999.
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Symptom diary is the whole point
The trace answers a specific question — what rhythm you were in when you felt unwell. Log every symptom.
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Distinct from a 24-hour Holter
This page covers continuous long-duration monitoring; for the general menu see the ambulatory ECG guide.
Red flags
When continuous monitoring is urgent, not elective.
The clinical situations that make continuous monitoring — often an ILR — a same-week priority rather than a routine work-up.
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Cryptogenic stroke with AF
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Sustained VT
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Complete heart block
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Sinus pause > 3 seconds with syncope
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Familial sudden cardiac death
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Wolff-Parkinson-White with AF
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Long QT syndrome with syncope
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Brugada pattern
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Congenital heart disease
Reading your report
An electrophysiology report can look intimidating. It isn’t.
Whatever the finding, the report keeps to the same four parts.
A quiet reminder
The report is written for your doctor, not for you — and that’s normal.
If you would like us to talk you through it before your follow-up, just ask.
- 01 Header
Indication, symptoms and device
Your details, the reason for monitoring, and the device deployed with recording period.
- 02 Technique
Recording quality and symptom log
Analysable percentage of the recording, the diary of triggered events, and the algorithm used for arrhythmia detection.
- 03 Findings
Arrhythmia burden and symptom correlation
AF burden %, ectopic count, longest pause, fastest and slowest rate, and — critically — the rhythm at each logged symptom.
- 04 Impression
The conclusion: read this first
A plain-English summary and the concrete next step — reassurance, ablation, pacemaker, ICD or structured cardiology follow-up.
Next steps
What the report leads to.
The trace decides the pathway — from reassurance through anticoagulation to structural device therapy.
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Reassurance if normal
A structurally clean two-week trace with no symptomatic arrhythmia is powerful reassurance.
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Rate control (AF)
Beta-blockers or calcium-channel blockers to control ventricular rate in atrial fibrillation.
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Rhythm control (AF)
Antiarrhythmic drugs or cardioversion when rhythm restoration is the goal.
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Anticoagulation per CHA₂DS₂-VASc
Stroke-risk-scored oral anticoagulation for confirmed atrial fibrillation.
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Ablation referral
Catheter ablation for symptomatic AF or SVT when medical therapy is insufficient.
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Pacemaker for symptomatic bradycardia
Permanent pacing for symptomatic sinus node dysfunction or high-grade AV block.
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Implantable defibrillator (ICD)
For sustained ventricular tachycardia or the highest-risk primary-prevention indications.
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Structured cardiology follow-up
A concrete review schedule so nothing is left to chance.
Recognised by major UK insurers
Cover depends on your policy and clinic; we confirm with your insurer before booking.
Frequently asked
Everything we get asked about continuous monitoring.
Quick answers on Zio patches, implantable loop recorders, cryptogenic stroke work-up and life during the recording.
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What does continuous ambulatory ECG monitoring show?
A continuous long-duration ECG recording — from 7 or 14 days on a skin patch up to 3 years on an implantable loop recorder. It captures paroxysmal atrial fibrillation, sinus pauses, non-sustained ventricular tachycardia, complete heart block episodes and symptom-rhythm correlation for palpitations, dizziness and syncope.
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How is this different from a 24-hour Holter?
A 24-hour Holter captures a single day. Continuous monitoring extends that window to two weeks (Zio patch, Nox) or up to three years (implantable loop recorder) — the diagnostic yield for paroxysmal arrhythmias is three to four times higher.
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What is a Zio patch?
The Zio (and equivalent Nox) patch is a small, waterproof, adhesive ECG recorder worn on the left chest for up to 14 days. Data uploads wirelessly and a cardiac electrophysiologist reads the trace at the end of the recording.
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What is an implantable loop recorder?
A paper-clip-sized ECG monitor inserted under the skin of the left chest under local anaesthetic — a five-minute outpatient procedure. It records continuously for up to three years and transmits nightly to the reading centre. The main indications are cryptogenic stroke work-up, recurrent unexplained syncope and rare high-risk arrhythmias.
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Why is this used after a cryptogenic stroke?
A stroke of unknown cause is often driven by occult, paroxysmal atrial fibrillation that a 24-hour Holter misses. Guidelines support ILR insertion in this group — detection changes anticoagulation and materially reduces recurrence risk.
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Can I shower with the patch?
Yes. Modern patches (Zio, Nox) are rated waterproof and designed for showering. Deep swimming or hot tubs are usually discouraged for the full recording period — check with your clinic.
Clinical sources
The guidance behind this guide.
- NICE. Atrial fibrillation: diagnosis and management (NG196).
- European Society of Cardiology. Guidelines on cardiac pacing and cardiac resynchronization therapy.
- Heart Rhythm Society. Consensus statement on catheter ablation of atrial fibrillation.
- American Heart Association. Guidelines on the management of patients with atrial fibrillation.
Reviewed by Pulse Atlas Editorial Board, . Last reviewed 2026-07-30. Next review 2027-07-30.
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In practice, in London
The honest picture around continuous ambulatory ECG monitoring in London
With continuous ambulatory ECG monitoring, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. The NHS route for continuous ambulatory ECG monitoring is thorough, but the queue is real. Most patients we speak with have been told to expect anywhere from a handful of weeks to several months, depending on their local trust and how the referral is graded. Going private in London usually collapses that window to a matter of days — often the same week if the diary allows. It isn’t about jumping a queue so much as buying time back while you still have the flexibility to plan around it.
A typical private booking for continuous ambulatory ECG monitoring in London starts with a consultant conversation — sometimes in person on Harley Street or Marylebone, sometimes on video if that suits better. Any imaging or diagnostics happen at a nearby CQC-registered facility, and reports usually land within 24 to 72 hours. The whole loop, from first call to written report, is often done inside a fortnight. For continuous ambulatory ECG monitoring specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Honesty about expectations is part of the job. A private continuous ambulatory ECG monitoring appointment in London won’t change the underlying medicine — the guidelines, the consultants, and the equipment are largely the same as on the NHS. What it changes is speed, continuity, and the amount of time you get to actually talk through the findings. Everyone we route to is GMC-registered and works within CQC-regulated facilities.
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