INTRODUCTION: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, accounting for up to one in five strokes. Identification of silent AF could reduce the total burden of stroke, particularly with newer, low-cost noninvasive methods of screening. We therefore performed a pilot study of ambulatory ECG monitoring to screen for AF. METHODS: We performed a prospective screening study by enrolling patients from May 2012 to January 2013 in outpatient clinics for cardiology, echocardiography, and stress testing at the VA Palo Alto Health Care System. Patient inclusion criteria were age ≥ 55 years and at least two of the following risk factors: coronary disease, congestive heart failure (CHF), hypertension, diabetes, and sleep apnea. We excluded patients with 1) a history of AF, supraventricular tachycardia, stroke, transient ischemic attack, systemic embolism, implantable pacemaker or defibrillator; 2) palpitations or syncope in the prior year. All patients received a small, wearable patch-based ambulatory ECG monitoring device (Zio® Patch, iRhythm Inc., San Francisco, CA) for up to two weeks of uninterrupted monitoring. The primary outcome was proportion of patients with AF. Secondary outcomes were prevalence of sustained and non-sustained ventricular tachycardia (NSVT) and supraventricular tachycardia (SVT). RESULTS: Among 57 patients (age 68 ± 7.4 years, 0% women), 53 (93%) completed ambulatory monitoring. The highest sites of enrollment were in cardiology clinic (47%) and echocardiography (46%). Atrial fibrillation was detected in three subjects (5.7%), who had a mean AF Burden of 4.2%. Common asymptomatic arrhythmias detected were SVT of ≥ 4 beats (N=37; 70%), ≥ 8 beats (N=24; 45%), and ≥ 60 seconds (N=4, 7.5%). Asymptomatic NSVT of ≥ 4 beats (N=16; 30%) and ≥ 8 beats (N=5, 9.4%) were also detected. CONCLUSION: Ambulatory screening of asymptomatic arrhythmias using the Zio® Patch is feasible; however the diagnostic yield for silent AF may be low, even among patients with established AF risk factors. Our study found a high prevalence of incidental asymptomatic SVT and NSVT. A larger trial with more targeted enrollment may be required to demonstrate the value of screening for AF. The impact of detecting incidental NSVT or SVT, which themselves could prompt evaluation and may be relevant to development of AF, requires further investigation.
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