Screening

Data from 17 studies involving 135,300 patients, mostly with chronic persistent atrial fibrillation (AF), showed that systematic screening with ECG identified more new cases of AF than no screening, with an absolute increase over 12 months of 0.6% to 2.8%.[95] However, one systematic approach using ECG did not detect more cases than an approach using pulse palpation.[95] Another systematic review and meta-analysis found that blood pressure monitors and non-12-lead ECGs were most accurate for detecting pulse irregularities caused by AF.[96] Modalities recommended for monitoring for new AF in patients hospitalized for another cause include episodic ECG or continuous ECG monitoring on telemetry; telemetry is more likely than episodic ECG to detect AF in this setting.[43]

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.[9][10][11]​ Stroke may be the initial presentation of AF; even subclinical AF, detected in patients with cardiac implantable electronic devices, is associated with an increased risk of stroke. Strategies for primary preventative screening for AF in high-risk stroke patients, such as remote monitoring of heart rhythm, can therefore be considered.[11][74][97]

There is no expert consensus or guideline recommendation on screening patients with asymptomatic AF in the US, because current evidence is inadequate to assess the balance of benefits and harms of screening for AF.[98] One systematic review and meta-analysis does advocate routine screening for undiagnosed AF from age 40, but large-scale screening of this nature is a difficult logistical and organizational undertaking. Screening for AF may be appropriate in higher-risk groups (e.g., patients implanted with a pacemaker or defibrillator) and can be performed with relative ease.[74][99] 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.[100]

Mobile health technologies, including smart devices, are a popular research area for AF detection.[75][76] There are currently >100,000 mobile health apps and ≥400 wearable activity monitors available. While some studies have demonstrated high sensitivity and specificity for detecting AF (including paroxysmal AF, which is short-lived and can be difficult to capture on 12-lead ECG), many devices are not clinically validated and caution is advised for clinical use.[2]​​[77][78][101] If AF is detected by mobile or wearable devices, diagnosis should always be confirmed with single-lead or 12-lead ECG analyzed by a physician with expertise in ECG rhythm interpretation.​[2]​

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