Screening

Stroke may be the initial presentation of atrial fibrillation (AF). Studies evaluating patients with a first-ever ischaemic stroke have found the prevalence of AF to be 15% to 25%.[4][5]​ Furthermore, studies assessing prolonged ECG monitoring (using a 30-day event-triggered recorder or an insertable cardiac monitoring device) in patients with cryptogenic stroke have found AF to be common in these patients.[94][95]​ Therefore, strategies for primary preventative screening for AF in patients at high risk of stroke can be considered. The US Preventive Services Task Force advises that current evidence is insufficient to assess the balance of benefits and harms of screening for AF.[96] There is no expert consensus or guideline recommendation on screening patients with asymptomatic AF. However, screening for AF can be performed in patients implanted with a pacemaker or defibrillator. In an observational study involving patients receiving an implantable pacemaker, new-onset AF and long-term AF burden were frequently observed in patients with heart block or sinus node disease, but were significantly more predominant in patients with sinus node disease in whom AF is part of the syndrome.[97]

Patients undergoing cancer treatment are at higher risk of AF, and should have an ECG as part of a baseline cardiovascular risk assessment.[61] Those at higher risk, for example those on certain chemotherapy agents, should be screened with more regular ECGs and/or opportunistic pulse taking.[61]

Mobile health technologies, including smart devices, have become a popular research area for AF detection.[87][88]​ A large number of mobile health apps and wearable activity monitors are available, but many are not clinically validated and caution is advised for clinical use.[1][2]​ If AF is detected by mobile or wearable devices, diagnosis should be confirmed with single-lead or 12-lead ECG analysed by a physician with expertise in ECG rhythm interpretation.[1]​​[2]​

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