Screening for paroxysmal atrial fibrillation in primary care using Holter monitoring and intermittent, ambulatory single-lead electrocardiography
| Autor: | Sébastien P.J. Krul, Jelle C L Himmelreich, Evert P.M. Karregat, Henri E J H Stoffers, Henri A.M. van Kesteren, Steven B Uittenbogaart, Justin G.L.M. Luermans, Nicole Verbiest-van Gurp, Henk van Weert, Wim A M Lucassen, Anne C. Bouwman |
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| Přispěvatelé: | General practice, Graduate School, ACS - Heart failure & arrhythmias, APH - Global Health, APH - Personalized Medicine, ACS - Atherosclerosis & ischemic syndromes, ANS - Neuroinfection & -inflammation, ANS - Neurovascular Disorders, Cardiology, ACS - Amsterdam Cardiovascular Sciences, APH - Quality of Care, Family Medicine, RS: CAPHRI - R5 - Optimising Patient Care, Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), RS: Carim - H01 Clinical atrial fibrillation, RS: CAPHRI - R6 - Promoting Health & Personalised Care |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Holter monitor
medicine.medical_specialty DEVICES Paroxysmal atrial fibrillation Diagnostic accuracy Primary care Electrocardiography Internal medicine medicine MANAGEMENT Prevalence Humans Mass Screening cardiovascular diseases Aged CARDIOLOGY RISK medicine.diagnostic_test Primary Health Care business.industry Atrial fibrillation PERFORMANCE medicine.disease Holter monitoring Ambulatory Cardiology Electrocardiography Ambulatory Screening Cardiology and Cardiovascular Medicine business STROKE |
| Zdroj: | International journal of cardiology, 345, 41-46. Elsevier Ireland Ltd International Journal of Cardiology, 345, 41-46. Elsevier Ireland Ltd |
| ISSN: | 0167-5273 |
| Popis: | BACKGROUND: Timely detection of atrial fibrillation (AF) is important because of its increased risk of thrombo-embolic events. Single time point screening interventions fall short in detection of paroxysmal AF, which requires prolonged electrocardiographic monitoring, usually using a Holter. However, traditional 24-48 h Holter monitoring is less appropriate for screening purposes because of its low diagnostic yield. Intermittent, ambulatory screening using a single-lead electrocardiogram (1 L-ECG) device can offer a more efficient alternative.METHODS: Primary care patients of ≥65 years participated in an opportunistic screening study for AF. We invited patients with a negative 12 L-ECG to wear a Holter monitor for two weeks and to use a MyDiagnostick 1 L-ECG device thrice daily. We report the yield of paroxysmal AF found by Holter monitoring and calculate the diagnostic accuracy of the 1 L-ECG device's built-in AF detection algorithm with the Holter monitor as reference standard.RESULTS: We included 270 patients, of whom four had AF in a median of 8.0 days of Holter monitoring, a diagnostic yield of 1.5% (95%-CI: 0.4-3.8%). In 205 patients we performed simultaneous 1 L-ECG screening. For diagnosing AF based on the 1 L-ECG device's AF detection algorithm, sensitivity was 66.7% (95%-CI: 9.4-99.2%), specificity 68.8% (95%-CI: 61.9-75.1%), positive predictive value 3.1% (95%-CI: 1.4-6.8%) and negative predictive value 99.3% (95%-CI: 96.6-99.9%).CONCLUSION: We found a low diagnostic yield of paroxysmal AF using Holter monitoring in elderly primary care patients with a negative 12 L-ECG. The diagnostic accuracy of an intermittently, ambulatory used MyDiagnostick 1 L-ECG device as interpreted by its built-in AF detection algorithm is limited. |
| Databáze: | OpenAIRE |
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