Screening for Atrial Fibrillation

Abstract

Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country- and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.

Contact‐Free Screening of Atrial Fibrillation by a Smartphone Using Facial Pulsatile Photoplethysmographic Signals

“…Limitations of all photoplethysmographic‐based devices include the need for a confirmatory ECG for suspected AF 11. Atrial or ventricular extrasystoles are well‐known causes of false‐positive results for photoplethysmographic devices that use RR‐interval variability analysis.…”

“…In recent years, several handheld devices, including stand‐alone and smartphone‐based devices and applications, have been developed for point‐of‐care AF screening 11, 12. The AliveCor heart monitor (AliveCor, San Francisco, CA) is a Food and Drug Administration–approved handheld single‐lead ECG device attached to a smartphone with an AF detection application.…”

Assessment of Remote Heart Rhythm Sampling Using the AliveCor Heart Monitor to Screen for Atrial Fibrillation

“…19, 20 A recent expert consensus article has confirmed that AF identified at screening is not benign and justifies consideration of anticoagulation in those with stroke risk factors. 21 Although validated handheld electrocardiographic recording devices are already considered appropriate technologies for AF screening, expert groups recognize that large prospective trials are required to strengthen the evidence base and to refine population screening strategies. 21 We therefore undertook a 1-year randomized controlled trial of twice-weekly monitoring with the AliveCor Kardia device (a smartphone/tablet-based single-lead electrocardiographic capture system) versus routine clinical care (RC) in patients >65 years of age with ≥1 additional stroke risk factor.…”

Cardiolaminopathies from bench to bedside: challenges in clinical decision-making with focus on arrhythmia-related outcomes

“…In view of the risk of stroke and thromboembolism related to atrial fibrillation, regardless of the presence/absence of symptoms like palpitations, periodic checks with a 12-lead electrocardiogram are indicated in patients with known cardiolaminopathy or in lamin A/C mutation carriers. The role of opportunistic or systematic screening, using hand-held devices for single-lead electrocardiogram or ECG event monitors or using more recent user-friendly tools, such as smartphones or bracelets with dedicated software, has still to be assessed in this specific context [39,40] but may be of great value in view of the relatively high pre-test probability of developing atrial tachyarrhythmias. Similarly, the diagnostic capabilities of implanted devices for bradyarrhythmias and prevention of sudden cardiac death (i.e.…”