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Heartbeat: Diagnosis of subclinical atrial fibrillation by physicians and patients
  1. Catherine M Otto
  1. Correspondence to Prof. Catherine M Otto, Division of Cardiology, University of Washington, Seattle, WA 98195, USA; cmotto{at}, cmotto{at}

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Atrial fibrillation (AF) is estimated to cause about 15% of all strokes, yet many patients with AF are asymptomatic, and thus, not diagnosed or treated with preventative anticoagulation. Our ability to monitor cardiac rhythm in ambulatory patients has increased dramatically in the last few years with numerous medical and consumer devices providing continuous heart rate or ECG monitoring. In this issue of Heart, Sejr and colleagues1 compared the accuracy of AF detection by 48 hours of external loop recording (ELR) versus simultaneous continuous ECG in a prospective study of 1412 patients with an acute stroke or transient ischaemia attack. Continuous ECG documented AF in 2.7% of patients—16% of these patients were missed on ELR. However, ELR suggested AF was present in five times more patients than were documented on continuous ECG recording; cardiologist verification reduced this number but was still associated with a high number of false positive diagnoses of AF (figure 1).

Figure 1

Flow diagram illustrating results of AF diagnostics in continuous ECG and ELR. Green marked boxes represent patients with AF in continuous ECG. AF, atrial fibrillation; ELR, external loop recorder.

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