Introduction Atrial fibrillation is often asymptomatic and un‐diagnosed in the community resulting in an increased risk of heart failure and stroke to those patients. We evaluated the effectiveness, tolerability, and accuracy of a novel six‐channel electrocardiogram digital‐health screening device, the RhythmPad, for the detection of atrial fibrillation. Methods Seven hundred and fifty‐two participants attending the cardiology department were recruited. Two recordings were taken—a six‐lead electrocardiogram using the RhythmPad device and a standard 12‐lead electrocardiogram. Recorded traces were analyzed by two blinded cardiologists. The computer‐generated automated diagnostic reports from both systems were also compared. Post‐participation feedback was obtained from study participants using a three‐part questionnaire. Results The sensitivity of the six‐lead electrocardiogram compared to the 12‐lead electrocardiogram, analyzed by two blinded cardiologists, for the detection of normal sinus rhythm was 95.9%, with a specificity of 97.2%. The sensitivity for the detection of atrial fibrillation using the six‐lead ECG was 93.4%, with specificity 96.8%. The six‐lead automated diagnostic report had a sensitivity and specificity of 97.5% and 98.6%, respectively, for correctly diagnosing normal sinus rhythm. For the correct diagnosis of atrial fibrillation, the six‐lead automated diagnostic report had a sensitivity and specificity of 95.4% and 98.8%, respectively. A total of 95.4% of participants found RhythmPad to be comfortable, with only 0.5% preferring the 12‐lead ECG device in comparison to six‐lead ECG acquisitions. Conclusion The RhythmPad digital health device and its automated diagnostic report were highly accurate in detecting atrial fibrillation when compared to a standard 12‐lead electrocardiogram.

Radiofrequency ablation (RFA) for the treatment of paroxysmal Atrial Fibrillation (pAF) has a class 1 indication in patients who have not tolerated or responded to antiarrhythmic medications. Antiarrhythmic medications (AAM) are, however, limited not only by modest efficacy, but also by significant side effects. Discontinuation rates for AAM range from 11-40% in trials. The RAAFT-2 trial evaluates the use of RFA as a first line treatment for pAF compared to optimal pharmacological management (1).

Atrial fibrillation is not only the most common clinical arrhythmia, it is also one of the most challenging conditions to treat in day-today clinical practice. In particular, the persistent form of this condition is not easily amenable to traditional forms of therapy, whereas, the paroxysmal form is far more responsive to standard modes of treatment. In our relentless quest to find better solutions to overcome persistent atrial fibrillation, arguably the most promising of these currently appears to be electrical isolation of the left atrial appendage. Whilst surgical amputation of the left atrial appendage for stroke prevention has been practiced for more than half a century, only recently has attention gradually been shifting to electrical isolation of the left atrial appendage for the treatment of persistent atrial fibrillation. In this review article, we present compelling pieces of evidence for the use of this strategy, and the various ways in which it can be achieved.

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