Searching for atrial fibrillation: looking harder, looking longer, and in increasingly sophisticated ways. An EHRA position paper'

被引:65
作者
Kalarus, Zbigniew [1 ,2 ]
Mairesse, Georges H. [3 ]
Sokal, Adam [2 ]
Boriani, Giuseppe [4 ]
Sredniawa, Beata [1 ,2 ]
Arroyo, Ruben Casado [5 ]
Wachter, Rolf [6 ]
Frommeyer, Gerrit [7 ]
Traykov, Vassil [8 ]
Dagres, Nikolaos [9 ]
Lip, Gregory Y. H. [10 ,11 ,12 ]
Boersma, Lucas [13 ,14 ]
Peichl, Petr [15 ]
Dobrev, Dobromir [16 ]
Bulava, Alan [17 ,18 ]
Blomstrom-Lundqvist, Carina [19 ]
de Groot, Natasja M. S. [20 ]
Schnabel, Renate [21 ]
Heinzel, Frank [22 ]
Van Gelder, Isabelle C. [23 ]
Carbuccichio, Corrado [24 ]
Shah, Dipen [25 ]
Eckardt, Lars [26 ]
机构
[1] Med Univ Silesia, Dept Cardiol, DMS Zabrze, Katowice, Poland
[2] Silesian Ctr Heart Dis, Dept Cardiol, Zabrze, Poland
[3] Clin Sud Luxembourg Vivalia, Dept Cardiol & Electrophysiol, Arlon, Belgium
[4] Univ Modena & Reggio Emilia, Policlin Modena, Dept Biomed Metab & Neural Sci, Cardiol Div, Modena, Italy
[5] Erasme Univ Hosp, Dept Cardiol, Brussels, Belgium
[6] Univ Hosp Leipzig, Clin & Policlin Cardiol, Leipzig, Germany
[7] Univ Hosp Munster, Dept Cardiol Electrophysiol 2, Munster, Germany
[8] Tokuda Hosp, Acibadem City Clin, Dept Invas Electrophysiol & Cardiac Pacing, Sofia, Bulgaria
[9] Univ Leipzig, Dept Electrophysiol, Heart Ctr Leipzig, Leipzig, Germany
[10] Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool, Merseyside, England
[11] Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England
[12] Aalborg Univ, Dept Clin Med, Aalborg, Denmark
[13] St Antonius Hosp, Dept Cardiol, Utrecht, Netherlands
[14] Amsterdam Univ Med Ctr, Amsterdam, Netherlands
[15] IKEM, Klin Kardiol, Prague, Czech Republic
[16] Univ Duisburg Essen, Fac Med, Inst Pharmacol, Essen, Germany
[17] Univ South Bohemia Ceske Budejovice, Fac Hlth & Social Sci, Ceske Budejovice, Czech Republic
[18] Palacky Univ, Fac Med & Dent, Olomouc, Czech Republic
[19] Uppsala Univ Hosp, Dept Med Sci & Cardiol, S-75185 Uppsala, Sweden
[20] Erasmus MC, Dept Cardiol Electrophysiol, Rotterdam, Netherlands
[21] Univ Heart & Vasc Ctr, Dept Cardiol, Hamburg, Germany
[22] Charite, Dept Cardiol, Campus Virchow Klinikum, D-13353 Berlin, Germany
[23] Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands
[24] Ctr Cardiol Monzino IRCCS, Dept Arrhythmol, Milan, Italy
[25] Cantonal Hosp, Dept Cardiol, CH-1211 Geneva, Switzerland
[26] Univ Clin Munster Ukm, Munster, Germany
来源
EUROPACE | 2023年 / 25卷 / 01期
关键词
Atrial fibrillation; Asymptomatic atrial fibrillation; AF screening; AF screening devices; AF populations at risk; Patient's benefits of AF screening; HEART RHYTHM SOCIETY; HIGH-RATE EPISODES; STROKE PREVENTION; CONSENSUS DOCUMENT; ISCHEMIC-STROKE; RISK SCORE; DEVICE; RATIONALE; DESIGN; BURDEN;
D O I
10.1093/europace/euac144
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The current AF definition requires recording in classical ECG or Holter ECG at least a 30-s episode of AF. According to the current definition, the presence of frequent shorter episodes of fast atrial arrhythmia or episodes of arrhythmia identified with widely used screening tools requires subsequent steps to establish a definite diagnosis of AF. The use of different clinical risk scores can help to refine target populations better. Due to the unpredictable and highly variable nature of AF episodes, a monitoring time lasting 2 weeks or longer is preferable to maximize the possibility of identifying subjects with AF. Several capabilities are currently available for AF search/screening, including devices based on plethysmographic pulse assessment, belts and vests for long-term ECG monitoring, modern Holter capabilities, and ILRs. Decision-making regarding using particular of them should depend on proof of efficacy based on published data, patient characteristics, and purpose of monitoring (screening/search). Additionally, all subjects with CIED with the possibility of atrial sensing should be carefully evaluated to identify AHREs. In large-scale screening projects, ML and AI could provide the appropriate interpretation of large databases containing the results of a giant number of participants. From the patient perspective, participation in screening has positive but also negative aspects. Therefore, each patient should be able to accept or refuse to participate in a screening programme, being fully aware of the potential benefits or hurdles of the screening. As the first step of shared decision-making, identifying a patient’s values, goals, and preferences is mandatory. © 2023 Oxford University Press. All rights reserved.
引用
收藏
页码:185 / 198
页数:14
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