BackgroundIndividuals with atrial fibrillation (AF) are at an increased risk for stroke. Early detection of undiagnosed AF by screening is recommended. Single‐lead electrocardiogram (ECG) is the most widely used technology in AF detection. Several systematic reviews on the diagnostic accuracy of single‐lead ECG devices for AF detection have been performed but have yielded inconclusive results.AimsThe aim of this study was to synthesize the available evidence on the effectiveness of single‐lead ECG devices in detecting AF.MethodsAn overview of systematic reviews was conducted. Five English databases (Cochrane Database of Systematic Reviews, PubMed, Embase, Ovid, and Web of Science) and two Chinese databases (Wanfang and CNKI) were searched from inception to July 31, 2021. Systematic reviews that examined the accuracy of tools based on single‐lead ECG technology for detecting AF were included. A narrative data synthesis was performed.ResultsEight systematic reviews were finally included. Systematic reviews with meta‐analysis showed that single‐lead ECG‐based devices had good sensitivity and specificity (both ≥90%) in detecting AF. According to subgroup analysis, the sensitivities of tools used in populations with a history of AF were all >90%. However, among handheld and thoracic placed single‐lead ECG devices, large variations in diagnostic performance were observed.Linking evidence to actionSingle‐lead ECG devices can potentially be used for AF detection. Due to the heterogeneity in the study population and tools, future studies are warranted to explore the suitable circumstances in which each tool could be applied for AF screening in an effective and cost‐effective manner.
BACKGROUND Atrial fibrillation (AF) carries increased risk for stroke, but much AF remains undiagnosed. Early detecting the undiagnosed AF via screening is suggested. Single-lead electrocardiogram (ECG) is the most widely used technology in AF detection. Several systematic reviews on the diagnostic accuracy of single-lead ECG devices for AF detection have been performed but yielded inconclusive results. OBJECTIVE To synthesize the available evidence on the effectiveness of single-lead ECG devices in detecting AF. METHODS Five English databases (Cochrane Database of Systematic Reviews, PubMed, Embase, Ovid, and Web of Science) and two Chinese databases (Wanfang and CNKI) were searched from the inception to July 31, 2021. Systematic reviews that examined the accuracy of tools based on single-lead ECG technology for detecting AF were included. A narrative data synthesis was performed. RESULTS Eight systematic reviews were finally included. Systematic reviews with meta-analysis showed that single-lead ECG based devices had good sensitivity and specificity (both ≥ 90%) in detecting AF. According to subgroup analysis, the sensitivities of tools used in populations with a history of AF were all greater than 90%. However, among handheld and thoracic placed single-lead ECG devices, large variations in their diagnostic performance were observed. CONCLUSIONS Single-lead ECG based devices have the potential for AF detection. While we were unable to determine the best option due to population heterogeneity and a lack of data on direct comparison between tools. Future studies are warranted to explore the suitable circumstance in which the effectiveness and cost-effectiveness these tools could be maximized for AF screening.
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