Feasibility of Extended Ambulatory Electrocardiogram Monitoring to Identify Silent Atrial Fibrillation in High‐risk Patients: The Screening Study for Undiagnosed Atrial Fibrillation (STUDY‐AF)

Abstract

BackgroundIdentification of silent atrial fibrillation (AF) could prevent stroke and other sequelae.HypothesisScreening for AF using continuous ambulatory electrocardiographic (ECG) monitoring can detect silent AF in asymptomatic in patients with known risk factors.MethodsWe performed a single-center prospective screening study using a wearable patch-based device that provides up to 2 weeks of continuous ambulatory ECG monitoring (iRhythm Technologies, Inc.). Inclusion criteria were age ≥55 years and ≥2 of the following risk factors: coronary disease, heart failure, hypertension, diabetes, sleep apnea. We excluded patients with prior AF, stroke, transient ischemic attack, implantable pacemaker or defibrillator, or with palpitations or syncope in the prior year.ResultsOut of 75 subjects (all male, age 69 ± 8.0 years; ejection fraction 57% ± 8.7%), AF was detected in 4 subjects (5.3%; AF burden 28% ± 48%). Atrial tachycardia (AT) was present in 67% (≥4 beats), 44% (≥8 beats), and 6.7% (≥60 seconds) of subjects. The combined diagnostic yield of sustained AT/AF was 11%. In subjects without sustained AT/AF, 11 (16%) had ≥30 supraventricular ectopic complexes per hour.ConclusionsOutpatient extended ECG screening for asymptomatic AF is feasible, with AF identified in 1 in 20 subjects and sustained AT/AF identified in 1 in 9 subjects, respectively. We also found a high prevalence of asymptomatic AT and frequent supraventricular ectopic complexes, which may be relevant to development of AF or stroke. If confirmed in a larger study, primary screening for AF could have a significant impact on public health.

A novel cross-sector telemedical approach to detect arrhythmia in primary care patients with palpitations using a patient-activated event recorder

“…This approach has been successfully employed in previous trials on posttherapeutic recurrence of AF: the device was equally effective as 7-day Holter monitoring [17] and is supported by the European Heart Rhythm Association guideline on indications for diagnostic loop recorders [5]. In a recently published STUDY--AF trial [18], an external continuous loop recorder with auto-detection of AF was used in asymptomatic patients with the following AF risk factors: coronary heart disease, heart failure, hypertension, diabetes mellitus, and sleep apnea to screen for silent AF. We could show a higher detection rate (5.3% vs. 10.3%) of de novo AF.…”

Transforming the care of atrial fibrillation with mobile health

“…The limitation of these devices in screening is the sampling error for detection of paroxysmal AF, which may indicate the substantially lower prevalence than what would be expected based on risk factors [19]. Population screening using patch-based adhesive 14-day monitors are underway ( [20] mSTOPS study), and pilot data shows promise, with diagnostic yields of 5 % in high-risk samples [21].…”

When Silence Isn’t Golden: The Case of “Silent” Atrial Fibrillation

“…9 Following catheter ablation for AF, post-procedure monitoring shows that the percentage of recurrent AF that is silent, rather than symptomatic, increases. 10,11 Modeling studies, such as that by Turakhia et al, 12 have estimated a high burden of clinically significant silent AF. The global burden is unknown.…”

“…Presumably, some of this will come out of the recently established AF-SCREEN international collaboration. 12 …”