Evaluation of ambulatory ECG monitoring as a Prognostic Tool in atrial fibrillation
DOI:
https://doi.org/10.5281/zenodo.22814698Keywords:
atrial fibrillation, ambulatory ECG monitoring, arrhythmia burden, subclinical atrial fibrillation, stroke preventionAbstract
Background: Atrial fibrillation is often paroxysmal and asymptomatic, so brief, symptom-triggered electrocardiography misses its true burden; ambulatory monitoring from Holter recordings to implantable loop recorders and wearables has revealed atrial fibrillation as a continuous, quantifiable burden rather than a binary diagnosis.
Objective: This review synthesizes evidence on ambulatory ECG monitoring as a prognostic tool in atrial fibrillation, covering detection performance across monitoring modalities, the relationship between device-measured burden and stroke or mortality risk, and trial evidence guiding anticoagulation in subclinical disease.
Methods: We synthesized randomized trials, prospective device-diagnostic registries, and guideline statements addressing monitoring modalities, arrhythmia burden, subclinical atrial fibrillation, and post-stroke and population screening applications.
Findings: Detection yield rises with monitoring duration and continuity across Holter, patch, and loop recorder comparisons; device-detected burden and episode duration predict stroke and mortality in graded fashion; and anticoagulation trials in subclinical atrial fibrillation show a net but narrower benefit than in clinical disease, with meaningful bleeding cost.
Conclusions: Ambulatory ECG monitoring is now a genuine prognostic instrument in atrial fibrillation, with burden functioning as a continuous risk variable guiding individualized anticoagulation decisions, though thresholds for the population identified through wearable screening remain incompletely validated.
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