Objective To investigate the feasibility and effectiveness of remote electrocardiogram monitoring (REM) in the diagnosis of arrhythmia by comparison with 12-lead electrocardiography (ECG) and ambulatory electrocardiograph (Holter). Methods A total of 142 patients with complains of chest distress, palpitation, dizziness and syncope admitted to Northern Jiangsu People’s Hospital from July 2012 to December 2013 were recruited in this study. During the follow-up period within 3 months, all patients underwent REM for a period from 1 week to 1 month, at the same time every day or when symptoms presented, and also received totally at least 3 times of ECG. Meanwhile, 72 of them received Holter examination. The 3 diagnostic modes were compared for the positive rates of arrhythmia. Results Ten cases out of the 142 patients were excluded from the study. There were 6 945 effective REM obtained from the rest 132 patients. Among them, 105 arrhythmia cases were detected by REM while 76 arrhythmia cases were detected by ECG (79.5% vs 57.6%, P＜0.05). However, there were 30 ST-T change cases by REM, and 26 ST-T change cases by ECG (22.7% vs 19.7%, P＞0.05). In 72 cases who had underwent Holter, REM had detected 62 arrhythmia cases and 21 ST-T change cases, while Holter detected 52 arrhythmia cases and 25 ST-T change cases. Significant difference was seen in the detection of arrhythmia (86.1% vs 72.2%, P＜0.05) but not in ST-T changes (29.2% vs 34.7% P＞0.05) between the 2 methods. Conclusion REM can accurately and timely detect arrhythmia, with near 100% of correct diagnosis, and more effective than ECG and Holter in the arrhythmia happening out of hospital.