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Catch Atrial Fibrillation, Prevent Stroke: Detection of atrial fibrillation and other arrhythmias with short intermittent ECG
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Atrial fibrillation (AF) is the most common arrhythmia in the adult population, affecting about 5% of the population over 65 years. Occurrence of AF is an independent risk factor for stroke, and together with other cardiovascular risk factors (CHADS2/CHA2DS2- VASc), the stroke risk increases. Since AF is often paroxysmal and asymptomatic (silent) it may remain undiagnosed for a long time and many AF patients are not discovered before suffering a stroke.

Aims: To estimate the prevalence of previously undiagnosed AF in an out-of-hospital population with CHADS2 ≥1, in patients with an enlarged left atrium (LA) and of total AF prevalence in sleep apnea (SA) patients, conditions that have been associated with AF. To compare the efficacy of short intermittent ECG with continuous 24h Holter ECG in detecting arrhythmias.

Methods: Patients without known AF recorded 10−30 second handheld ECG (Zenicor-EKG®) registrations during 14−28 days at home, both regular, asymptomatic registrations twice daily and when having cardiac symptoms. Recordings were transmitted through the in-built SIM card to an internet-based database. Patients with palpitations or dizziness/presyncope referred for 24h Holter ECG were asked to additionally record 30-second handheld ECG registrations during 28 days at home.

Results: In the out-of-hospital population with increased stroke risk, previously unknown AF was diagnosed in 3.8% of 928 patients. Comparing AF detection in patients with an enlarged LA versus normal LA showed that eleven of 299 patients had AF. Five of these had an enlarged LA (volume/BSA). No statistical difference in AF prevalence was found between patients with enlarged and normal LA, 3.3% and 3.2% respectively, (p = 0.974). AF occurred in 7.6% of 170 patients with sleep apnea, in 15% of patients with sleep apnea ≥60 years, and in 35% of patients with central sleep apnea. AF prevalence was also associated with severity of sleep apnea, male gender and diabetes. Comparing the efficacy of arrhythmia detection in 95 patients with palpitations or dizziness/presyncope with continuous 24h Holter and short intermittent ECG, 24h Holter found AF in two and AV-block II in one patient, resulting in 3.2% relevant arrhythmias detected. Short intermittent ECG diagnosed nine patients with AF, three with PSVT and one with AV-block II, in total 13.7% relevant arrhythmias. (p = 0.0094).

Conclusions: Screening in the out-of-hospital patient population (mean age 69.8 years) yielded almost 4% AF, making it seem worthwhile to screen older patients with increased stroke risk for AF with this method. Screening patients with LA enlargement (mean age 73.1 years) did not result in higher detection rates compared with the general out-of-hospital population. AF occurred in 7.6% of patients with sleep apnea, (mean age 57.6 years) and was associated with severity of sleep apnea, presence of central sleep apnea, male gender, age ≥60 years, and diabetes. Short intermittent ECG is more effective in detecting relevant arrhythmias than 24h Holter ECG in patients with palpitations or dizziness/presyncope.

Place, publisher, year, edition, pages
Umeå: Umeå University , 2015. , 78 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1695
Keyword [sv]
atrial fibrillation, screening, primary prevention, secondary prevention, handheld ECG
National Category
Family Medicine
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:umu:diva-100497ISBN: 978-91-7601-200-0 (print)OAI: oai:DiVA.org:umu-100497DiVA: diva2:792348
Public defence
2015-03-27, Sal 135, Byggnad 9, NUS, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-03-06 Created: 2015-03-03 Last updated: 2015-03-27Bibliographically approved
List of papers
1. Screening for atrial fibrillation with baseline and intermittent ECG recording in an out-of-hospital population
Open this publication in new window or tab >>Screening for atrial fibrillation with baseline and intermittent ECG recording in an out-of-hospital population
2013 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 13, no 1, 41- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: the objective of this study is to investigate the detection rate of undiagnosed atrial fibrillation (AF) with short intermittent ECG recordings during four weeks among out-of-hospital patients, having at least one additional risk factor (CHADS2) for stroke.

METHOD: Design: Cross-sectional study. Setting: Eight family practice centres and two hospital-based out-patient clinics in Sweden. Subjects: 989 out-of-hospital patients, without known AF, having one or more risk factors associated with stroke (CHADS2). Interventions: All individuals were asked to perform 10-second handheld ECG recordings during 28 days, twice daily and when having palpitations. Main outcome measures: Episodes of AF on handheld ECG recordings were defined as irregular supraventricular extrasystoles in series with a duration of 10 seconds.

RESULTS: 928 patients completed registration. AF was found in 35 of 928 patients; 3.8% (95% confidence interval [CI] 2.7--5.2). These 35 patients had a mean age of 70.7 years (SD +/- 7.7; range 53--85) and a median CHADS2 of 2 (range 1--4). CONCLUSIONS: Intermittent handheld ECG recording over a four week period had a detection rate of 3.8% newly diagnosed AF, in a population of 928 out-of-hospital patients having at least one additional risk factor for stroke. Intermittent handheld ECG registration is a feasible method to detect AF in patients with an increased risk of stroke in whom oral anticoagulation (OAC) treatment is indicated.

Place, publisher, year, edition, pages
BioMed Central, 2013
Keyword
Arrhythmia, Atrial fibrillation, Handheld ECG, Stroke prevention, Screening
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-73635 (URN)10.1186/1471-2261-13-41 (DOI)
Available from: 2013-06-25 Created: 2013-06-25 Last updated: 2017-12-06Bibliographically approved
2. Intermittent short ECG recording is more effective than 24-hour Holter ECG in detection of arrhythmias
Open this publication in new window or tab >>Intermittent short ECG recording is more effective than 24-hour Holter ECG in detection of arrhythmias
Show others...
2014 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 14, 41- p.Article in journal (Refereed) Published
Abstract [en]

Background: Many patients report symptoms of palpitations or dizziness/presyncope. These patients are often referred for 24-hour Holter ECG, although the sensitivity for detecting relevant arrhythmias is comparatively low. Intermittent short ECG recording over a longer time period might be a convenient and more sensitive alternative. The objective of this study is to compare the efficacy of 24-hour Holter ECG with intermittent short ECG recording over four weeks to detect relevant arrhythmias in patients with palpitations or dizziness/presyncope.

Methods:

Design: prospective, observational, cross-sectional study. Setting: Clinical Physiology, University Hospital. Patients: 108 consecutive patients referred for ambiguous palpitations or dizziness/presyncope.

Interventions: All individuals underwent a 24-hour Holter ECG and additionally registered 30-second handheld ECG (Zenicor EKG ((R)) thumb) recordings at home, twice daily and when having cardiac symptoms, during 28 days.

Main outcome measures: Significant arrhythmias: atrial fibrillation (AF), paroxysmal supraventricular tachycardia (PSVT), atrioventricular (AV) block II-III, sinus arrest (SA), wide complex tachycardia (WCT).

Results: 95 patients, 42 men and 53 women with a mean age of 54.1 years, completed registrations. Analysis of Holter registrations showed atrial fibrillation (AF) in two patients and atrioventricular (AV) block II in one patient (= 3.2% relevant arrhythmias [95% CI 1.1-8.9]). Intermittent handheld ECG detected nine patients with AF, three with paroxysmal supraventricular tachycardia (PSVT) and one with AV-block-II (= 13.7% relevant arrhythmias [95% CI 8.2-22.0]). There was a significant difference between the two methods in favour of intermittent ECG with regard to the ability to detect relevant arrhythmias (P = 0.0094). With Holter ECG, no symptoms were registered during any of the detected arrhythmias. With intermittent ECG, symptoms were registered during half of the arrhythmia episodes.

Conclusions: Intermittent short ECG recording during four weeks is more effective in detecting AF and PSVT in patients with ambiguous symptoms arousing suspicions of arrhythmia than 24-hour Holter ECG.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keyword
Arrhythmias, Atrial fibrillation, Electrocardiography, Holter ECG, Intermittent ECG
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-88955 (URN)10.1186/1471-2261-14-41 (DOI)000334546200001 ()
Available from: 2014-05-23 Created: 2014-05-19 Last updated: 2017-12-05Bibliographically approved
3. Screening for atrial fibrillation in patients with left atrial enlargement
Open this publication in new window or tab >>Screening for atrial fibrillation in patients with left atrial enlargement
Show others...
(English)In: Article in journal (Other academic) Submitted
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-100518 (URN)
Available from: 2015-03-04 Created: 2015-03-04 Last updated: 2015-06-11Bibliographically approved
4. Atrial fibrillation in patients with sleep apnea
Open this publication in new window or tab >>Atrial fibrillation in patients with sleep apnea
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Cardiac and Cardiovascular Systems Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-100519 (URN)
Available from: 2015-03-04 Created: 2015-03-04 Last updated: 2015-06-11Bibliographically approved

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