Non-invasive characteristics of atrial fibrillation: the value of Holter recordings for the treatment of AF

Atrial fibrillation (AF) is the most common arrhythmia in man associated with significantmorbidity and excess mortality. AF can be lone but is frequently associated with underlying heartdisease while in some patients a genetic cause has been identified. In the past decade our knowledge about themechanisms of AF and our options for (non)pharmacological treatment of AF have increased importantly.Since the success rate of drug therapy is frequently disappointing hybrid therapy is oftennecessary (e.g., drugs in combination with cardioversion, pacemaker implantation or an ablationprocedure). Therapy should focus on identifying the specific substrate (underlying heart disease)and triggers for AF in each patient, making a more individualized therapy possible. For this, non-invasivetesting becomes more and more important. Holter recordings may show focal activity (monomorphic atrialpremature beats, atrial tachycardia) or other supraventricular arrhythmias (AV-nodal reentranttachycardia, circus movement tachycardia) which can successfully be treated. In addition, AF may transientlyconvert to atrial flutter (AFL), either spontaneously or after administration of (class IC)drugs. Recent studies have shown that ablation of the flutter circuit or ectopic activity can cure AF in many ofthese patients.