Monitoring of atrial tachyarrhythmias

Atrial fibrillation, the most common tachyarrhythmia, significantly reduces the quality of life of patients and is associated with 15% of strokes. With the aging of the population, it is beginning to reach epidemic proportions. Guidelines for management of atrial tachyarrhythmias exist but in order to implement them, it needs early diagnosis and execution of treatment strategies. Atrial tachyarrhythmias are treated by drugs, ablative therapies, implantable electrical devices or external Cardioversion. An ideal monitoring systems should diagnose the tachyarrhythmia early and provide adequate information to help define the appropriate treatment strategy. Presently, external monitoring systems are routinely used for diagnosis. Although they are effective in patients with palpitations, their value is significantly limited in asymptomatic patients or those with other symptoms as well as for evaluating the efficacy and safety of treatment. Many of these limitations can be addressed with chronically implantable devices because of their accurate detection and ability to store large amounts of data. Presently, implantable devices are indicated for patients with Bradyarrhythmias and Tachyarrhythmias who can benefit from the electrical therapy provided by the devices. About a third to half of these patients have concurrent atrial tachyarrhythmias. The extensive information available from some of the recently available devices should provide significant value for diagnosing atrial tachyarrhythmias, optimizing treatment strategies and improving morbidity and mortality. This needs to be investigated with prospective trials. In the future, if the diagnostic information can be shown to have significant value, these devices may be implanted for their diagnostic capabilities only.