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Is pulse palpation helpful in detecting atrial fibrillation? A systematic review
Georga Cooke1, Jenny Doust, Sharon Sanders
1University of Queensland, Australia.
Insights
Pulse palpation is a sensitive screening tool for detecting atrial fibrillation (AF) in older adults. While not perfectly specific, its high sensitivity makes it useful for ruling out AF and opportunistic screening.
Area of Science:
- Cardiology
- Geriatric Medicine
- Diagnostic Accuracy Studies
Background:
- Atrial fibrillation (AF) is a prevalent and serious condition in the elderly.
- An irregularly irregular pulse is a key clinical sign of AF.
Purpose of the Study:
- To evaluate the diagnostic accuracy of pulse palpation for detecting atrial fibrillation.
- To compare pulse palpation against electrocardiogram (ECG) diagnosis.
Main Methods:
- Systematic literature search of Medline, EMBASE, and review articles.
- Inclusion of studies comparing pulse palpation with ECG for AF diagnosis.
- Independent data extraction and quality assessment by two reviewers.
Main Results:
- Analysis of 3 studies involving 2385 patients.
- Pooled sensitivity of pulse palpation for AF was 94% (95% CI, 84%-97%).
- Pooled specificity was 72% (95% CI, 69%-75%), with a negative likelihood ratio of 0.10.
Conclusions:
- Pulse palpation demonstrates high sensitivity but moderate specificity for AF detection.
- It is effective for ruling out atrial fibrillation and for opportunistic screening in the elderly.
- Opportunistic screening in those over 65 could identify cases requiring ECG confirmation.
Background:
Atrial fibrillation in the elderly is common and potentially life threatening. The classical sign of atrial fibrillation is an irregularly irregular pulse.
Objective:
The objective of this research was to determine the accuracy of pulse palpation to detect atrial fibrillation.
Methods:
We searched Medline, EMBASE, and the reference lists of review articles for studies that compared pulse palpation with the electrocardiogram (ECG) diagnosis of atrial fibrillation. Two reviewers independently assessed the search results to determine the eligibility of studies, extracted data, and assessed the quality of the studies.
Results:
We identified 3 studies (2385 patients) that compared pulse palpation with ECG. The estimated sensitivity of pulse palpation ranged from 91% to 100%, while specificity ranged from 70% to 77%. Pooled sensitivity was 94% (95% confidence interval [CI], 84%-97%) and pooled specificity was 72% (95% CI, 69%-75%). The pooled positive likelihood ratio was 3.39, while the pooled negative likelihood ratio was 0.10.
Conclusions:
Pulse palpation has a high sensitivity but relatively low specificity for atrial fibrillation. It is therefore useful for ruling out atrial fibrillation. It may also be a useful screen to apply opportunistically for previously undetected atrial fibrillation. Assuming a prevalence of 3% for undetected atrial fibrillation in patients older than 65 years, and given the test's sensitivity and specificity, opportunistic pulse palpation in this age group would detect an irregular pulse in 30% of screened patients, requiring further testing with ECG. Among screened patients, 0.2% would have atrial fibrillation undetected with pulse palpation.
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