Abstract
Background: Timely detection of atrial fibrillation (AF) is important because of its increased risk of thrombo-embolic events. Single time point screening interventions fall short in detection of paroxysmal AF, which requires prolonged electrocardiographic monitoring, usually using a Holter. However, traditional 24-48 h Holter monitoring is less appropriate for screening purposes because of its low diagnostic yield. Intermittent, ambulatory screening using a single-lead electrocardiogram (1 L-ECG) device can offer a more efficient alternative.Methods: Primary care patients of ≥65 years participated in an opportunistic screening study for AF. We invited patients with a negative 12 L-ECG to wear a Holter monitor for two weeks and to use a MyDiagnostick 1 L-ECG device thrice daily. We report the yield of paroxysmal AF found by Holter monitoring and calculate the diagnostic accuracy of the 1 L-ECG device's built-in AF detection algorithm with the Holter monitor as reference standard.Results: We included 270 patients, of whom four had AF in a median of 8.0 days of Holter monitoring, a diagnostic yield of 1.5% (95%-CI: 0.4–3.8%). In 205 patients we performed simultaneous 1 L-ECG screening. For diagnosing AF based on the 1 L-ECG device's AF detection algorithm, sensitivity was 66.7% (95%-CI: 9.4–99.2%), specificity 68.8% (95%-CI: 61.9–75.1%), positive predictive value 3.1% (95%-CI: 1.4–6.8%) and negative predictive value 99.3% (95%-CI: 96.6–99.9%).Conclusion: We found a low diagnostic yield of paroxysmal AF using Holter monitoring in elderly primary care patients with a negative 12 L-ECG. The diagnostic accuracy of an intermittently, ambulatory used MyDiagnostick 1 L-ECG device as interpreted by its built-in AF detection algorithm is limited.
Highlights
Atrial fibrillation (AF) is a common cardiac arrhythmia and a major cause of stroke, heart failure and other cardiovascular morbidity [1]
From patients with at least one algorithmpositive 1 L-ECG recording, we investigated how often cardiologists were able to make an accurate diagnosis of atrial fibrillation (AF) by visual assessment of the 1 L-ECG recordings with the Holter monitoring as reference standard
Because in none of those 14 patients AF was diagnosed on the Holter monitor, we assumed they did not have AF on the 12 L-ECG either, we included them in this analysis
Summary
Atrial fibrillation (AF) is a common cardiac arrhythmia and a major cause of stroke, heart failure and other cardiovascular morbidity [1]. Anticoagulant treatment of AF reduces the risk of thrombo-embolic events by more than 60% [2,3,4] This is especially relevant in elderly patients, in whom both the prevalence of AF and the thrombo-embolic risk are increased [5,6]. To detect paroxysmal AF, prolonged continuous monitoring with electrocardiography (ECG), using for example a Holter monitor, is advocated [1]. A prevalence of paroxysmal AF up to 6% was found with prolonged ECG monitoring, after a negative baseline ECG in high risk patients [8]. Detection of atrial fibrillation (AF) is important because of its increased risk of thromboembolic events. Single time point screening interventions fall short in detection of paroxysmal AF, which re quires prolonged electrocardiographic monitoring, usually using a Holter. Intermittent, ambu latory screening using a single-lead electrocardiogram (1 L-ECG) device can offer a more efficient alternative
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