24 Hour ECG Clinical Guidance - Ecclesfield Group Practice

Author: Michelle Payling, Practice Manager, Ecclesfield Group Practice 

Date published: November 2023 

Date to review: August 2024

Ecclesfield Group Practice 

96a Mil Road, 


Sheffield S35 9XQ 

Telephone: 0114 2469030

Conditions treated: 


Dizzy ? secondary to Cardio conduction Disorder




Assessment of rate control for Atrial Fibrillation

Stage 1 – The consultation

It is up to the patients GP to determine whether the patient has a level of risk which requires specialist assessment.

The patients GP should take a history and perform any necessary examination. If this reveals any high-risk factors (see below) then there should be a referral to an appropriate specialist service. Patients who at clinical interview or examination have severe symptoms or have high risk (eg FHx, sudden death under 40 years) should be excluded from this pathway and be referred to a specialist service. Other symptoms which raise clinical concern, should be discussed with an appropriate clinician to decide if a 24-hour ECG would be helpful or not.

Low Risk group

Patients who fulfil the following criteria should initially be treated conservatively:

No history of sustained tachycardia or loss of consciousness AND

Good exercise capacity AND

No family history of Sudden Cardiac Death < 40 years AND

Normal cardiac examination AND

Normal 12 lead ECG 

Patients with significant abnormalities detected in the 12-lead ECG should be referred to secondary care.

Before referral to the 24-hour ECG Service, a resting 12-lead ECG and appropriate blood tests should be carried out. 

Patients will be required to attend on two successive days. The first day they will have the monitor attached which is then removed the following day.

Please let the patients know that they cannot have a shower when the leads are fitted and that they should not try and remove the leads during this period.

The machine must be returned to the practice the next working day.

Procedures Performed

24 ECG fitting

Stage 2 – referral to local service provider for 24-hour ECG investigation

Referrals to Ecclesfield Group Practice for a 24-hour ECG should be made using the ERS booking system, attaching a copy of the complete referral form (which can be found on the Press portal).    Practices can book a direct appointment for the patient.   

Ecclesfield Group Practice will fit the patient with the device and provide the patient with an information leaflet and contact details for the practice, should any problems/concerns arise. We will advise the patient on the time to return the device the following day to the surgery.

Stage 3

Designated staff at Ecclesfield Group Practice will download the recordings and transmit for interpretation using a secure electronic method along with the original referral form.


Should a patient fail to attend an appointment and does not contact the Surgery to re-book, Ecclesfield Group Practice will inform the referring GP.

Stage 4

The Provider of this service will send a report back to the patients registered GP electronically by NHS.net.

Stage 5

The patient is informed of the results by their registered practice and managed as appropriate.

Note – the Provider should aim to not undertake any repeat scanning of patients unless there is clinical rationale for the repeat scan.