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, 38 (5), 285-92

Feasibility of Extended Ambulatory Electrocardiogram Monitoring to Identify Silent Atrial Fibrillation in High-Risk Patients: The Screening Study for Undiagnosed Atrial Fibrillation (STUDY-AF)


Feasibility of Extended Ambulatory Electrocardiogram Monitoring to Identify Silent Atrial Fibrillation in High-Risk Patients: The Screening Study for Undiagnosed Atrial Fibrillation (STUDY-AF)

Mintu P Turakhia et al. Clin Cardiol.


Background: Identification of silent atrial fibrillation (AF) could prevent stroke and other sequelae.

Hypothesis: Screening for AF using continuous ambulatory electrocardiographic (ECG) monitoring can detect silent AF in asymptomatic in patients with known risk factors.

Methods: We performed a single-center prospective screening study using a wearable patch-based device that provides up to 2 weeks of continuous ambulatory ECG monitoring (iRhythm Technologies, Inc.). Inclusion criteria were age ≥55 years and ≥2 of the following risk factors: coronary disease, heart failure, hypertension, diabetes, sleep apnea. We excluded patients with prior AF, stroke, transient ischemic attack, implantable pacemaker or defibrillator, or with palpitations or syncope in the prior year.

Results: Out of 75 subjects (all male, age 69 ± 8.0 years; ejection fraction 57% ± 8.7%), AF was detected in 4 subjects (5.3%; AF burden 28% ± 48%). Atrial tachycardia (AT) was present in 67% (≥4 beats), 44% (≥8 beats), and 6.7% (≥60 seconds) of subjects. The combined diagnostic yield of sustained AT/AF was 11%. In subjects without sustained AT/AF, 11 (16%) had ≥30 supraventricular ectopic complexes per hour.

Conclusions: Outpatient extended ECG screening for asymptomatic AF is feasible, with AF identified in 1 in 20 subjects and sustained AT/AF identified in 1 in 9 subjects, respectively. We also found a high prevalence of asymptomatic AT and frequent supraventricular ectopic complexes, which may be relevant to development of AF or stroke. If confirmed in a larger study, primary screening for AF could have a significant impact on public health.


Figure 1
Figure 1
Zio patch symptom trigger button and device placement. Subjects were instructed to press the symptomatic event trigger (A) if symptoms such as dizziness, chest pain, shortness of breath, or heart palpitations developed during monitoring. Device placement (B) for the wearable adhesive patch–based device is over the patient's left pectoral region. (Images courtesy of iRhythm Technologies Inc., San Francisco, CA.)
Figure 2
Figure 2
The study flow chart shows detailed inclusion and exclusion criteria for study participation and completion. Abbreviations: AF, atrial fibrillation; SVT, supraventricular tachycardia; TIA, transient ischemic attack.
Figure 3
Figure 3
Sample rhythm strips exhibiting episodes of (A) AF, (B) sustained SVT that was determined to be AT, and (C) NSVT detected in separate study participants. Abbreviations: AF, atrial fibrillation; AT, atrial tachycardia; NSVT, nonsustained ventricular tachycardia; SVT, supraventricular tachycardia.

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