Comprehensive Evaluation of Rhythm Monitoring Strategies in Screening for Atrial Fibrillation: Insights From Patients...

Area of Science:

• Cardiology
• Public Health
• Medical Technology

Background:

• Stroke is a growing global health concern.
• Atrial fibrillation (AF) is a primary stroke risk factor, increasing the importance of AF screening.
• Emerging monitoring technologies are driving advancements in AF detection strategies.

Purpose of the Study:

• To evaluate the performance of various screening strategies for detecting atrial fibrillation (AF).
• To assess population characteristics associated with higher diagnostic yield in AF screening.
• To compare the effectiveness of different monitoring durations and frequencies against implantable loop recorders.

Main Methods:

• Recruited individuals with stroke risk factors but no AF for screening using implantable loop recorders.
• Monitored participants continuously for over 3 years, reconstructing detailed heart rhythm data.
• Simulated various screening strategies using random sampling to assess sensitivity and negative predictive value compared to the loop recorder.

Main Results:

• A single 10-second ECG had low sensitivity (1.5%) for AF detection, while 30 days of continuous monitoring reached 34% sensitivity.
• Increased sensitivity was observed with longer monitoring durations, dispersed monitoring periods, and repeated screenings.
• Higher sensitivity for AF detection was consistently found in older participants (≥75 years), males, those with higher CHADS₂ scores (>2), and elevated NT-proBNP levels (≥40 pmol/L).

Conclusions:

• The diagnostic yield of AF screening strategies increases with monitoring duration, dispersion, and frequency.
• All tested screening strategies showed lower yield compared to continuous monitoring with an implantable loop recorder.
• Older age, male sex, and elevated NT-proBNP are associated with higher sensitivity in AF screening.