Atrial Fibrillation Detection
Fishing for An Irregular Heartbeat Before and After Stroke
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- atrial fibrillation
- cardioembolic stroke
- cryptogenic stroke
- embolic stroke of unknown source
See releated articles, pp 2653, 2654, 2660, 2665
Atrial fibrillation (AF) is present in ±3% of the general population above age 20, and its prevalence increases substantially in the ≥65-year-olds age group.1 It is expected that AF prevalence will increase as populations get older. AF is asymptomatic in ≤40% of patients. Unfortunately, the absence of symptoms does not suggest a benign course.2 The Framingham Heart Study found that stroke is the first manifestation of AF in at least 2% to 5% of AF patients.3 In a hospital-based series, ≤20% of stroke patients had previously unidentified or unrecognized AF.4 AF also increases the risk of cognitive impairment and dementia.5 Identifying AF and reducing stroke risk in patients with AF before stroke occurs is, therefore, an important goal.
Should We Detect AF in the General Population Prior to Stroke?
Whether screening for AF in the general population is warranted is heavily debated. Opportunistic screening refers to screening offered to people as part of a routine medical checkup or when examined for another reason, whereas systematic screening entails screening in the general population (ie, mass screening) or a high-risk, target group (ie, patients with heart failure or diabetes mellitus). Opportunistic screening in patients aged >65 years with pulse palpation or ECG rhythm strip is the current recommended method by the European Society of Cardiology.6 No recommendation is given in the US guidelines.7 Pulse palpation is sensitive for detection of permanent AF (the sensitivity is 94%, and its specificity is 72%) but is not specific and requires confirmation with ECG. The equipment and time required to perform an ECG examination are a significant barrier to perform screening, but fortunately new methods for screening are being developed rapidly.8 Proponents of screening cite the relatively high frequency of AF, the ease of detection and prevention of …