Usefulness of continuous electrocardiographic monitoring for atrial fibrillation

The problem of early recognition of atrial fibrillation (AF) is greatly aggravated by the often silent nature of the rhythm disturbance. In about 1/3 of patients with this arrhythmia, patients are not aware of the so-called asymptomatic AF. In the past 15 years, the diagnostic data provided by implanted pacemakers and defibrillators have dramatically increased knowledge about silent AF. The unreliability of symptoms to estimate AF burden and to identify patients with and without AF has been pointed out not only by pacemaker trials but also in patients without implanted devices. The technology for continuous monitoring of AF has been largely validated. It is a powerful tool to detect silent paroxysmal AF in patients without previously documented arrhythmic episodes, such as those with cryptogenic stroke or other risk factors. Early diagnosis triggers earlier treatment for primary or secondary stroke prevention. Today, new devices are also available for pure electrocardiographic monitoring, implanted subcutaneously using a minimally invasive technique. In conclusion, this recent and promising technology adds relevant clinical and scientific information to improve risk stratification for stroke and may play an important role in testing and tailoring the therapies for rhythm and rate control.