Atrial Fibrillation Monitoring

Abstract

In today's clinical practice the diagnosis of atrial fibrillation (AF) is made by an ECG documentation that fulfills established criteria.1 That documentation is of utmost clinical importance because it is the basis for further therapeutic interventions, such as rhythm control strategies or introduction of oral anticoagulation. ECG documentation of AF, however, carries 2 distinct limitations. First, the occurrence is unpredictable in terms of onset and duration of arrhythmia episodes. Second, patient symptoms are of limited value identifying arrhythmia episodes and to subsequently enable successful ECG recordings. As such, multiple studies have described a high prevalence of asymptomatic or silent AF in various patient populations.2–8 Article see p 806 To better characterize the arrhythmia, to improve outcome assessment after therapeutic interventions, and to optimize individual clinical decisions, methodologies of more and more intense rhythm monitoring have entered clinical and scientific use. Traditionally applied techniques have evolved from rhythm strip, 12-lead ECG, and 24-hour Holter to 7-day Holter and various modes of transtelephonic monitoring.1 Studies have documented the incremental benefit in the rate of AF detection obtained with intensified monitoring efforts. After AF catheter ablation arrhythmia recurrences were documented in 17% versus 45% of the same patient population, depending on follow-up with 24-hour versus 7-day Holter monitoring.9 Daily transtelephonic monitoring, on the other hand, showed to be equally effective in detecting AF recurrences compared with the 7-day Holter.6 Needless to say, all these techniques are intermittent and discontinuous (ie, rhythm snapshots of variable duration and …