<p>We sought to compare the diagnostic efficacy of a 72-hour wearable electrocardiography (ECG) patch monitoring with a conventional 24-hour Holter monitoring for the detection of cardiogenic vertigo. We conducted a prospective multicenter study that recruited 47 patients suspected of cardiogenic vertigo in four referral-based university hospitals between November 2019 and April 2022. Patients received simultaneous ambulatory ECG recordings using a 72-hour wearable ECG patch monitoring and a conventional 24-hour Holter monitor. The primary outcome was the detection rate of arrhythmia events during the entire wearing period. The secondary outcomes included device preference and factors affecting the detection of cardiogenic vertigo. During the 72-hour monitoring period, there was no significant difference in the overall detection rate of arrhythmia events between the wearable patch and conventional Holter monitoring (10 of 47 [21.3%] vs. 8 of 47 [17.0%], <i>p</i> = .500) Most patients (46/47) favored a wearable patch over Holter monitoring. The effectiveness of wearable ECG patch monitoring was comparable to conventional Holter monitoring in detecting cardiogenic vertigo. With its extended monitoring capability and patient preference, wearable patch monitoring holds promise as an alternative method for the diagnosis of cardiogenic vertigo. Limitations of this study include small sample size and selection bias.</p>