The Holter ECG ecosystem comprises a defined set of upstream, midstream, and downstream actors that collectively enable the design, production, distribution, and clinical use of ambulatory electrocardiography monitoring solutions. Upstream, component manufacturers supply sensors, batteries, and micro‑electronics that form the hardware foundation. Midstream participants integrate these parts into finished devices, embed firmware, and certify compliance with medical standards. Downstream, distributors, service organizations, and health‑care providers deliver the devices to patients and capture clinical data for diagnosis and research. Value is created through the conversion of raw components into regulated, data‑rich monitoring systems and captured by manufacturers, service contracts, and data‑analytics arrangements. The ecosystem also relies on third‑party data aggregation platforms that transform raw ECG streams into actionable clinical insights, supporting research collaborations and algorithm refinement.