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, Aditya J. Ullal, Donald D. Hoang, Claire T. Than, Jared Miller, Karen J. Friday, Marco V. Perez, James V. Freeman, Paul J. Wang, Paul A. Heidenreich

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)285-292
Number of pages8
JournalClinical Cardiology
Volume38
Issue number5
DOIs
StatePublished - May 1 2015
Externally publishedYes

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Ambulatory Monitoring
Atrial Fibrillation
Electrocardiography
Tachycardia
Ambulatory Electrocardiography
Stroke
Supraventricular Tachycardia
Defibrillators
Transient Ischemic Attack
Sleep Apnea Syndromes
Syncope
Coronary Disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Feasibility of extended ambulatory electrocardiogram monitoring to identify silent atrial fibrillation in high-risk patients : The screening study for undiagnosed atrial fibrillation (STUDY-AF). / Turakhia, Mintu P.; Ullal, Aditya J.; Hoang, Donald D.; Than, Claire T.; Miller, Jared; Friday, Karen J.; Perez, Marco V.; Freeman, James V.; Wang, Paul J.; Heidenreich, Paul A.

In: Clinical Cardiology, Vol. 38, No. 5, 01.05.2015, p. 285-292.

Research output: Contribution to journalArticle

Turakhia, Mintu P. ; Ullal, Aditya J. ; Hoang, Donald D. ; Than, Claire T. ; Miller, Jared ; Friday, Karen J. ; Perez, Marco V. ; Freeman, James V. ; Wang, Paul J. ; Heidenreich, Paul A. / Feasibility of extended ambulatory electrocardiogram monitoring to identify silent atrial fibrillation in high-risk patients : The screening study for undiagnosed atrial fibrillation (STUDY-AF). In: Clinical Cardiology. 2015 ; Vol. 38, No. 5. pp. 285-292.
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abstract = "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.",
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AU - Turakhia, Mintu P.

AU - Ullal, Aditya J.

AU - Hoang, Donald D.

AU - Than, Claire T.

AU - Miller, Jared

AU - Friday, Karen J.

AU - Perez, Marco V.

AU - Freeman, James V.

AU - Wang, Paul J.

AU - Heidenreich, Paul A.

PY - 2015/5/1

Y1 - 2015/5/1

N2 - 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.

AB - 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.

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