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Symptoms are insensitive and non-specific for the diagnosis of atrial fibrillation (AF). Extensive Holter monitor recordings are essential to correctly diagnose AF and, subsequently, to inform therapeutic decisions for its management. Pacemakers and implantable cardioverter defibrillators that detect atrial arrhythmias are a valuable resource for the investigation and quantification of AF. The application of these monitoring systems, however, is limited to a relatively small number of patients. Additional monitoring technologies are therefore necessary to detect the large number of asymptomatic AF episodes, as well as their resulting morbidities (including stroke and heart failure) and mortality. New, non-invasive systems could allow outsourcing of long-term Holter monitoring from the hospital, with attendant improvements in the extent of Holter monitoring and the quality of recording results. Subcutaneous implantable systems, with automated detection algorithms for atrial arrhythmias, represent a new opportunity for long-term rhythm monitoring. In summary, improving implantable cardiac monitors for AF detection could allow us not only to objectively evaluate the efficacy of different therapies but also to refine the future therapeutic management of AF.

Implantable Cardiac Monitors for the Detection of Atrial Fibrillation – How Far Have We Come?