Subclinical and Device-Detected Atrial Fibrillation: Pondering the Knowledge Gap: A Scientific Statement From the American Heart Association

Noseworthy, Peter A.; Kaufman, Elizabeth S.; Chen, Lin Y.; Chung, Mina K.; Elkind, Mitchell S.V.; Joglar, José A.; Leal, Miguel A.; McCabe, Pamela J.; Pokorney, Sean D.; Yao, Xiaoxi; Biology, Vascular

doi:10.1161/cir.0000000000000740

Cited by 132 publications

(100 citation statements)

References 55 publications

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“…The devices range from intermittent and minimally invasive wearable monitors, such as electronic watches, to continuous and implanted devices, such as pacemakers or defibrillators. 1 Adhesive patches are the most common wearable device to assess for AF; they have sensors measuring ECGs, whereas wristbands or watches often use photoplethysmography. Rhythm evaluation using photoplethysmography is less dependable than is continuous intracardiac ECG monitoring via invasive devices.…”

Section: Reviewmentioning

confidence: 99%

“…Rhythm evaluation using photoplethysmography is less dependable than is continuous intracardiac ECG monitoring via invasive devices. 1 Although cardiac implanted electronic devices (CIEDs) with atrial leads provide the best detection of AF, the noninvasive and convenient nature of wearable monitors exponentially will increase the detected incidence of SCAF in the foreseeable future.…”

Section: Reviewmentioning

confidence: 99%

“…13,15,16 Although Noseworthy et al noted that not all strokes are directly linked to AF, multiple studies have shown a correlation between AF burden and embolic incidence. 1 The authors then reviewed studies searching for SCAF prevalence after a stroke. In one meta-analysis of 50 studies that followedup with patients with embolic stroke of undetermined source, SCAF was present in 24% of cases.…”

Section: Reviewmentioning

confidence: 99%

“…SCAF presents a cardiologist with multiple quandaries, including the initiation of stroke prophylaxis, and if so, how to proceed. 1 Surgical patients presenting with SCAF can be a challenge for the anesthesiologist; therefore, this review explores the perioperative implications for the anesthesiology team.…”

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confidence: 99%

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Device-Detected Subclinical Atrial Fibrillation: The Anesthesiologist's Perspective

Ghia

Mehta

Bhatt

2020

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

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confidence: 99%

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Device-Detected Subclinical Atrial Fibrillation: The Anesthesiologist's Perspective

Ghia

Mehta

Bhatt

2020

Journal of Cardiothoracic and Vascular Anesthesia

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“…Once diagnosed, the stroke risk of AF can be effectively reduced with oral anticoagulation therapy (Kirchhof et al, 2016). The threshold of AF burden to cause marked risk of recurrent stroke is still to be defined, but there is clear evidence that poststroke detected AF increases the risk of recurrent stroke, leading to a need to establish AF diagnosis and initiate anticoagulation without delays (Chou et al, 2018;Noseworthy et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Prolonged ECG with a novel recorder utilizing electrode belt and mobile device in patients with recent embolic stroke of undetermined source: A pilot study

Lumikari

Pirinen

Putaala

et al. 2020

Noninvasive Electrocardiol

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Background: Paroxysmal atrial fibrillation (pAF) is a major risk factor for ischemic stroke, but challenging to detect with routine short-term monitoring methods. In this pilot study, we present a novel method for prolonged ECG and screening for pAF in patients with a recent embolic stroke of unknown source (ESUS). Methods: Fifteen patients aged ≥ 50 years with a recent ESUS were assigned to wear an external electrode belt-based 1-lead ECG device (Beat2Phone) continuously for 2 weeks (wear time). The device was operated via a mobile phone application in nonhospital conditions. The primary outcome was patient adherence to monitoring. Secondary outcomes were incidence of new pAF, quality-wise comparison to Holter, and usability of the novel ECG monitoring method with Systems Usability Scale (SUS). We also performed a 24-to 48-hr comparison between simultaneous Beat2Phone ECG and a standard Holter in 6 patients. Results: Wear time of Beat2Phone device was over 80% in 5 (33.3%) patients, 50%-80% in 7 (46.6%) patients, and less than 50% in 3 (20%) patients. We detected pAF ≥ 30 s in 1 patient (6.7%). In the simultaneous monitoring with Beat2Phone and Holter, there were a total of 817 (out of 1979) analyzable periods of sinus rhythm or premature atrial or ventricular beats (Cohen's Kappa coefficient 0.92 ± 0.02 between Beat2Phone and Holter), and no pAF events. Beat2Phone ECG showed remarkable SUS scores in user evaluations (average score: 81.4 out of 100 on SUS). Conclusions: Beat2Phone device was easy to use among ESUS patients and in optimal conditions provided high-quality 1-lead ECG signal for diagnosing pAF. Clinical trial registration: The study was not registered, as it was a nonrandomized single-arm pilot study.

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Screening for Atrial Fibrillation

Davidson

Barry

Mangione

et al. 2022

JAMA

110

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ImportanceAtrial fibrillation (AF) is the most common cardiac arrhythmia. The prevalence of AF increases with age, from less than 0.2% in adults younger than 55 years to about 10% in those 85 years or older, with a higher prevalence in men than in women. It is uncertain whether the prevalence of AF differs by race and ethnicity. Atrial fibrillation is a major risk factor for ischemic stroke and is associated with a substantial increase in the risk of stroke. Approximately 20% of patients who have a stroke associated with AF are first diagnosed with AF at the time of the stroke or shortly thereafter.ObjectiveTo update its 2018 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the benefits and harms of screening for AF in older adults, the accuracy of screening tests, the effectiveness of screening tests to detect previously undiagnosed AF compared with usual care, and the benefits and harms of anticoagulant therapy for the treatment of screen-detected AF in older adults.PopulationAdults 50 years or older without a diagnosis or symptoms of AF and without a history of transient ischemic attack or stroke.Evidence AssessmentThe USPSTF concludes that evidence is lacking, and the balance of benefits and harms of screening for AF in asymptomatic adults cannot be determined.RecommendationThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AF. (I statement)

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Subclinical and Device-Detected Atrial Fibrillation: Pondering the Knowledge Gap: A Scientific Statement From the American Heart Association

Cited by 132 publications

References 55 publications

Device-Detected Subclinical Atrial Fibrillation: The Anesthesiologist's Perspective

Device-Detected Subclinical Atrial Fibrillation: The Anesthesiologist's Perspective

Prolonged ECG with a novel recorder utilizing electrode belt and mobile device in patients with recent embolic stroke of undetermined source: A pilot study

Screening for Atrial Fibrillation

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