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The Future of Cardiac Monitoring: MCOT Monitor vs. ECG Holter


The landscape of long-term cardiac monitoring is rapidly changing. ECG/EKG Holter has long been the standard for extended heart monitoring, but with MCOT monitors gaining popularity, the question arises: will it replace ECG Holter? For practitioners, how do they choose the most suitable method for accurate AF detection and patient care?

 

Read on to explore these questions and learn how to optimize arrhythmia management for better diagnostic outcomes.


Patient Wearing a multi-lead ECG Holter during sleep

What is MCOT?


Mobile Cardiac Telemetry (MCT or MCOT) is an advanced, portable heart monitoring system that uses chest electrodes to continuously record and transmit cardiac data. It enables extended monitoring from 24 hours up to 30 days. When the MCOT system detects irregular heart rhythms or abnormalities, it immediately notifies a designated individual at an authorized diagnostic center, who then contacts the physician for prompt review and appropriate care.[1][2]

 

Patient Wearing an MCOT Monitor
Patient Wearing an MCOT Monitor

What is ECG Holter?                                                                                                                                       

Unlike MCOT, which forms a closed loop from recording to detection and alarming, an ECG/EKG Holter monitor is a wearable device that primarily records the heart's electrical activity using electrodes attached to the chest. It typically records for 24 to 72 hours, though longer durations are possible for certain modes. The Holter system usually includes a recorder (hardware) that captures the electrical signals and outputs cardiac reports, and software for reviewing and analyzing the data. Many ECG Holter monitors feature a “patient button” that allows patients to annotate specific events or symptoms during recording, which are then marked in the ECG report for further review. Additionally, ECG Holters do not have real-time alert capabilities.[3]


working Wearing an ECG Holter
Patient Wearing an ECG Holter

Comparison Sheet: MCOT vs. ECG Holter


Comparison Sheet between MCOT and ECG Holter
*Data based on Viatom ECG Holter ER1-LW and Lepod Pro.


Benefits of MCOT monitor over ECG Holter


  • Immediate Intervention and Treatment


In ECG Holter monitoring, though the ECG waveform is typically transmitted via software, the comprehensive analysis requires waiting until the entire testing period is complete before the ECG data is reviewed by the physician.


In contrast, MCOT provides continuous communication, enabling real-time analysis and instant alerts. This immediacy allows healthcare providers to conduct prompt emergency responses and emergent interventions for potentially life-threatening events such as arrhythmias, significantly enhancing patient safety and care outcomes.


  • Superior PAF Detection in Cryptogenic Stroke Patients


There are some specific situations in which MCOT is preferred over traditional ECG Holter monitoring. For patients with cryptogenic stroke and transient ischemic attacks (TIA), MCOT is notably more effective, primarily because the prolonged monitoring period strongly increases the detection likelihood. Previous study indicates that a 17.3% detection rate of occult paroxysmal atrial fibrillation (PAF) during up to 30 days, with the highest rate of 19.5% observed at 21 days, highlighting that extended MCOT monitoring significantly improves PAF identification compared to shorter ECG Holter evaluations.[4]


  • Sensitive Drug Therapy Monitoring


In the management of post-procedure monitoring and therapy adjustments, the MCOT system provides a distinct advantage over the ECG Holter monitor due to its real-time analysis and 7/24 patient support. For example, MCOT is vital for antiarrhythmic drug therapies, which often have pro-arrhythmic potential (like Torsades de Pointes from QT prolongation)[5], as its emergent notifications sent to the clinicians greatly contribute to dose adjustment and drug discontinuation in response to dangerous side effects. Notably, research found that 61% of MCOT users are diagnosed with arrhythmia, compared to 24% with Holter monitors.[6]


  • Enhanced Patient Wearing Experience


MCOT generally offers a more comfortable wearing experience compared to ECG Holter monitors. Holter devices can be single or multi-lead, typically comprising a two-piece system with the main monitor and electrodes (sensors) connected by lead wires.[7] While multi-lead setups provide more comprehensive data, the wires and electrode patches can sometimes impact patient comfort.


In contrast, most MCOT devices are single-lead in a single piece, featuring an integrated monitor, and sometimes include additional sensors such as accelerometers and body position sensors. Designed to be lightweight and wireless, MCOT devices generally offer greater comfort, especially during long-term heart monitoring.


ECG Holter is still the choice for most monitoring solutions


While some advocate that Mobile Cardiac Outpatient Telemetry (MCOT) enhances diagnosis accuracy, improves arrhythmia management, and reduces hospital costs compared to Holter monitors[6], recent studies highlight key differences:


  • Reliable Human-Based Detection


MCOT typically relies on automated detection algorithms to analyze extensive ECG data. When detecting arrhythmias such as tachycardia or atrial fibrillation, the algorithms automatically mark the event start times and abnormal segments, transmitting alerts in real-time to clinicians.

 

With continuous upgrades in algorithms and the integration of AI recognition, MCOT's timeliness in alerts significantly stands out from other cardiac monitoring methods. However, despite these advancements, errors such as false alarms or missed events can still happen. In contrast, ECG Holter monitoring with human-based analysis provides the most reliable and clinically meaningful insights. Studies show that human-based detection in long-term continuous electrocardiogram (LT-ECG) is three times more accurate than algorithm-based MCT, identifying 3 times the number of clinically relevant arrhythmias and providing better diagnostic context.[8]

 

Moreover, for complex or atypical ECG waveforms, manual interpretation considering clinical symptoms and patient histories by trained clinicians remains more reliable, making ECG Holter monitors still a trusted choice for detecting heart issues like arrhythmia episodes and arrhythmia subtypes, including ventricular tachycardia, AV block, and AV node reentrant tachycardia, which covers larger patient populations.


  • Reduced Financial Pressure


According to recent research, there is a significant difference in the costs of these two cardiac monitoring systems for both providers and patients. Specifically, the data indicate that the average facility fee for MCOT is approximately $717.05, markedly higher than the $167.61 for Holter monitoring[9] due to advanced equipment, specialized staff, data management systems, and so on. Moreover, the effectiveness of MCOT in significantly reducing long-term healthcare costs is still being validated. As a result, most hospitals and clinics remain cautious about adopting MCOT, primarily weighing the cost-benefit considerations before making a decision.

 

From the patient's perspective, the out-of-pocket expenses are around $149 for MCOT, compared to only about $39 for Holter monitoring[9] due to the overall service pricing and reimbursement rates.

 

Considering that facility charges significantly influence provider decision-making, especially for smaller or cost-sensitive clinics, the substantial cost gap remains a pivotal factor guiding the preferred option of ECG Holter monitors over MCOT systems in routine cardiac care.


Higher Facility Fee of MCOT for Providers [9]
Higher Facility Fee of MCOT for Providers [9]

Higher Out-of-pocket Cost of MCOT for Patients [9]
Higher Out-of-pocket Cost of MCOT for Patients [9]

  • Less Restrictive Insurance Policies


Taking the insurance policy in the U.S. as an example, Holter monitoring is a common and widely reimbursed diagnostic procedure, with relatively fixed reimbursement amounts. Insurance companies typically require only a review of the clinical case and testing records, and the approval process generally takes 7 to 14 business days. As a result, for most patients suspected of having or already diagnosed with underlying heart conditions, Holter monitoring remains a standard and widely used method for routine cardiac assessment.


Medical Insurance Criteria for ECG Holter in the U.S.
Medical Insurance Criteria for ECG Holter in the U.S. [10]

 

In contrast, coverage and reimbursement for MCOT are more stringent. The approval process requires extensive clinical documentation to justify the MCOT necessity, including the physician's progress notes, detailed records of previous monitoring logs, specific information about the timing of cardiac events, etc. Since MCOT involves remote data transmission, the insurance provider’s review should also verify that the data is accurate and trustworthy. Consequently, the overall review timeline of MCOT often exceeds one month. Insurer providers tend to be more cautious with MCOT and have a higher rate of claim denials.

 

Medical Insurance Criteria for MCOT in U.S. [11]
Medical Insurance Criteria for MCOT in the U.S. [11]

  • Established Workflow Integration


Within a high-density, fast-paced clinical environment, practitioners continue to prefer ECG Holter monitors mainly because they are well-established within clinical workflows. For hospitals and clinics considering the adoption of MCOT, the process extends beyond simply purchasing the devices. They must also deploy the software, set up cloud-based data transmission and storage services, and integrate MCOT systems with their existing hospital information system to ensure that physicians can access real-time heart rate data for multi-user management. Additionally, hospitals need to prepare a 24/7 medical team to respond quickly to alarms and emergencies.[12]


A 2022 survey involving 100 U.S. clinicians—including cardiologists, electrophysiologists, nurse practitioners, and physician assistants—revealed that despite the upgraded performance of MCOT, half of the respondents found Holter monitors easier to operate, highlighting Holters’ familiarity, simpler use, even though the equipment tends to be bulkier. Moreover, many respondents cited the complexity of newer MCOT systems and the lack of training as barriers to adoption.[13] Overall, while usage of MOCT is expected to increase, ECG Holter remains the preferred, practical choice for most healthcare providers.


  • Flexible Device Compatibility


Currently, MCOT systems are mainly available from Philips, which limits options for healthcare providers and reduces system flexibility. The MCOT market is progressing cautiously because developing the hardware, data transmission methods, algorithms, and assembling the necessary teams all require substantial time and funding, making the prospects for expanding product diversity remain constrained. As a result, reliance on specialized telemetry-enabled devices and the limited product range hinders customization to meet specific clinical needs.


In contrast, with minimized workflow interference, ECG Holter monitors boast a much wider variety of device models and manufacturers. For example, Viatom is committed to ongoing ECG/EKG Holter innovation, enhancing its Holter product lineup to better serve diverse monitoring requirements. So far, Viatom’s ECG Holter monitor lineup features high-accuracy multi-lead options, diverse shapes, and multiple wearing configurations, ensuring comprehensive and flexible diagnostic solutions. Additionally, other brands like GE, AliveCor, and iRhythm also provide great choices. This diversity and availability provide healthcare providers with greater flexibility to select devices that best suit their clinical demands.


Recommended ECG Holter products


Currently, ECG Holter monitoring continues to be the predominant choice across healthcare settings. Its established reliability and widespread familiarity make it the default option for many clinicians, despite emerging technologies.

 

In the ECG Holter market, Viatom’s ECG Holter series stands out for its proven performance and versatility, making it suitable for a wide range of clinical scenarios. Viatom’s ECG Holters boost clinically proven anti-interference technology and extend dynamic response range. For instance, the Viatom ER1-LW ECG Holter provides discreet, compact, and ultra-comfortable single-lead monitoring for 24 to 72 hours. Additionally, the Lepod Pro ECG Holter offers professional-grade, uninterrupted 1, 7, 8, or 12-lead recording, suitable for comprehensive diagnostic assessments.

Patient wearing Viatom ER1-LW ECG Holter in Two Ways
Patient wearing Viatom ER1-LW ECG Holter in Two Ways

 

Patient wearing Viatom Lepod Pro ECG Holter Checking Real-time ECG Waveforms
Patient wearing Viatom Lepod Pro ECG Holter Checking Real-time ECG Waveforms

 

Key product features across the Viatom ECG Holter series include:

 

  • Anti-interference recording tech

  • Enhanced user comfort

  • Double-click event marker

  • Wireless connectivity

  • Mobile app integration

  • Clinically-ready ECG reports

  • ...


Conclusion


While MCOT offers a longer monitoring period and real-time expert intervention, traditional ECG Holters like Viatom’s ECG Holter series remain the standard due to their proven reliability and affordability. Moving forward, to meet patient needs effectively, a balanced approach that combines innovation with efficiency will optimize cardiac care practice for clinical and remote care settings.


References:


[1] Holter, Event & MCOT Monitor | beats cardiology (2024)

[2] MOBILE CARDIAC TELEMETRY(MCT) - Health Heart Cardiology (2024)

[3] Holter monitor - Wikipedia (2025)

[4] Outpatient cardiac telemetry detects a high rate of atrial fibrillation in cryptogenic stroke (2013)

[5] Proarrhythmic potential of antimicrobial agents (2008)

[6] Benefits of monitoring patients with mobile cardiac telemetry (MCT) compared with the Event or Holter monitors (2013)

[7] Advances in Mobile Cardiac Outpatient Telemetry | TELE rhythmics (2020)

[8] Continuous ECG monitoring versus mobile telemetry: A comparison of arrhythmia diagnostics in human- versus algorithmic-dependent systems (2021)

[9] A cost comparison of atrial fibrillation monitoring strategies after embolic stroke of undetermined source (2022)

[10] Billing and Coding: Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) | Centers for Medicare & Medicaid Services (2025)

[11] Mobile Cardiac Outpatient Telemetry MCOT | Blue Cross Blue Shield of North Dakota (2025)

[12] Philips Mobile Cardiac Telemetry - MCOT (2022)

[13] Holter Monitor Turns 60: Are These Heart Monitoring Devices On Their Way Out? (2022)

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