Possibilities of screening for asymptomatic atrial fibrillation in clinical practice

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Abstract

Currently, atrial fibrillation (AF) occupies one of the leading positions among cardiac arrhythmias. Given the steady trend towards an increase in the prevalence of risk factors and the development of early complications in the progression of AF, early detection of asymptomatic and short-term paroxysms of this arrhythmia is of particular relevance. Timely diagnosis of AF will certainly prevent the progression of electrophysiological and anatomical and morphological atrial remodeling, which will ensure the cessation of arrhythmia, turning into a nosological form, and carry out appropriate preventive measures. In the modern arsenal of a practicing physician, there is a fairly large list of methods for screening AF. Undoubtedly, the development of new technologies that allow for the rapid and early diagnosis of AF will expand, making a significant contribution to reducing the burden of AF in the population. Pocket, portable ECG recorders, patch monitors, smartphones, smartwatches, photoplethysmography signal analysis using a smartphone camera, and many other innovative developments in the field of screening for undiagnosed AF provide rapid detection of AF, allowing timely initiation of optimal medical therapy to avoid cardiovascular complications. The purpose of this review is to expand the understanding of the possibilities and choice of adequate methods for screening AF in real clinical practice.

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About the authors

Ivan A. Stepanenko

S.M. Kirov Military Medical Academy

Author for correspondence.
Email: dr.eone@yandex.ru
ORCID iD: 0000-0001-6436-5656
SPIN-code: 9174-8800

Cand. Sci. (Med.), Lecturer at the 1st Department of Therapy (Advanced Medical Education), Department of Therapy (Advanced Medical Education) n.a. N.S. Molchanov

Russian Federation, St. Petersburg

D. I. Sopova

S.M. Kirov Military Medical Academy

Email: dr.eone@yandex.ru
ORCID iD: 0000-0002-0823-6435
SPIN-code: 8739-3691

Department of Therapy (Advanced Medical Education) n.a. N.S. Molchanov

Russian Federation, St. Petersburg

V. V. Salukhov

S.M. Kirov Military Medical Academy

Email: dr.eone@yandex.ru
ORCID iD: 0000-0003-1851-0941
SPIN-code: 4531-6011

Department of Therapy (Advanced Medical Education) n.a. N.S. Molchanov

Russian Federation, St. Petersburg

E. L. Zaslavskaya

Pavlov Medical University

Email: dr.eone@yandex.ru
ORCID iD: 0000-0002-1209-7765

Department of Therapy Faculty with a Course of Endocrinology and Cardiology with the Clinic n.a. G.F. Lang

Russian Federation, St. Petersburg

V. A. Tarasov

S.M. Kirov Military Medical Academy

Email: dr.eone@yandex.ru
SPIN-code: 4140-4921

Department of Therapy (Advanced Medical Education) n.a. N.S. Molchanov

Russian Federation, St. Petersburg

I. I. Novikov

S.M. Kirov Military Medical Academy

Email: dr.eone@yandex.ru
ORCID iD: 0000-0002-7581-5867
SPIN-code: 8213-0277

Department of Therapy (Advanced Medical Education) n.a. N.S. Molchanov

Russian Federation, St. Petersburg

References

  1. Lippi G., Sanchis-Gomar F., Cervellin G. Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge. Int J Stroke. 2021;16(2):217–21. doi: 10.1177/1747493019897870.
  2. Freedman B., Lowres N. Silent atrial fibrillation. 2018. Р. 2132–35. doi: 10.1093/med/9780198784906.003.0500.
  3. Wang Q.-C., Wang Z.-Y. Big Data and Atrial Fibrillation: Current Understanding and New Opportunities. J Cardiovasc Transl Res. 2020;13(6):944–52. doi: 10.1007/s12265-020-10008-5.
  4. Hindricks G., et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373–498. doi: 10.1093/eurheartj/ehaa612.
  5. Nishtala A., et al. Atrial fibrillation and cognitive decline in the Framingham Heart Study. Heart Rhythm. 2018;15(2):166–72. doi: 10.1016/j.hrthm.2017.09.036.
  6. Petryszyn P., et al. Effectiveness of screening for atrial fibrillation and its determinants. A meta-analysis. PLOS ONE. 2019;14(3):e0213198. doi: 10.1371/journal.pone.0213198.
  7. Orchard J., et al. eHealth Tools to Provide Structured Assistance for Atrial Fibrillation Screening, Management, and Guideline-Recommended Therapy in Metropolitan General Practice: The AF-SMART Study. J Am Heart Assoc. 2019;8(1):e010959. doi: 10.1161/JAHA.118.010959.
  8. Van Gelder I.C., et al. Duration of device-detected subclinical atrial fibrillation and occurrence of stroke in ASSERT. Eur Heart J. 2017;38(17):1339–44. doi: 10.1093/eurheartj/ehx042.
  9. Российское кардиологическое общество научного общества специалистов по клинической электрофизиологии, аритмологии и кардиостимуляции Ассоциации сердечно-сосудистых хирургов России. Клинические рекомендации «Фибрилляция и трепетание предсердий» (Электронный ресурс). [Russian Society of Cardiology Scientific Society of Specialists in Clinical Electrophysiology, Arrhythmology and Pacing of the Association of Cardiovascular Surgeons of Russia. Clinical guidelines «Atrial fibrillation and flutter» (Electronic resource). (In Russ.)]. URL: https://scardio.ru/content/Guidelines/2020 (дата доступа / access date: 30.11.2021).
  10. Christopoulos G., et al. Artificial Intelligence–Electrocardiography to Predict Incident Atrial Fibrillation: A Population-Based Study. Circ Arrhythm Electrophysiol. 2020;13(12):e009355. doi: 10.1161/CIRCEP.120.009355.
  11. Поляков А.С. и др. Оптимальный выбор антикоагулянтной профилактики при неклапанной фибрилляции предсердий в период пандемии Covid-19. Российский кардиологический журнал. 2021;26(8). [Polyakov A.S., et al. Optimal choice of anticoagulant prophylaxis for non-valvular atrial fibrillation during the Covid-19 pandemic. Russ J Cardiol=Rossiiskii kardiologicheskii zhurnal. 2021;26(8). (In Russ.)]. doi: 10.26442/20751753.2022. 4.201543.
  12. Крюков Е.В. и др. Возможности контроля эффективности и безопасности применения ривароксабана у пациентов, страдающих фибрилляцией предсердий. Вестник Российской Военно-медицинской академии. 2021;2(74). [Kryukov E.V., et al. V Possibilities of monitoring the efficacy and safety of rivaroxaban in patients with atrial fibrillation. Vestnik Rossiiskoi Voenno-meditsinskoi akademii. 2021;2(74). (In Russ.)]. doi: 10.17816/brmma64961.
  13. Conen D., et al. Relationships of Overt and Silent Brain Lesions With Cognitive Function in Patients With Atrial Fibrillation. J Am Coll Cardiol. 2019;73(9):989–99. doi: 10.1016/j.jacc.2018.12.039. Doi:
  14. Kim D., et al. Risk of dementia in stroke-free patients diagnosed with atrial fibrillation: data from a population-based cohort. Eur Heart J. 2019;40(28):2313–23. doi: 10.1093/eurheartj/ehz386.
  15. Stepanenko I., et al. Atrial Flutter as the First Manifestation of Progressive Cardiac Conduction Disease in a Young Apparently Healthy Patient: А Case Report. Med Univ. 2019;2(4):139–42. doi: 10.2478/medu-2019-0019.
  16. Салухов В.В., Ильинская Т.А., Минаков А.А. Влияние современной сахароснижающей терапии на массу тела у больных сахарным диабетом 2 типа. Эндокринология. Новости. Мнения. Обучение. 2022;11(1):39–52. [Salukhov V.V., Il’inskaya T.A., Minakov A.A. Influence of modern hypoglycemic therapy on body weight in patients with type 2 diabetes mellitus. Endokrinologiya. Novosti. Mneniya. Obuchenie. 2022;11(1):39–52. (In Russ.)]. doi: 10.33029/2304-9529-2022-11-1-39-52.
  17. Фролов Д.С. и др. Применение дистанционного мобильного мониторирования с помощью электрокардиографа ECG-DONGLE у пациентов, страдающих хронической сердечной недостаточностью. Вестник Российской Военно-медицинской академии. 2021;23(4):71–8. [Frolov D.S., et al. Application of remote mobile monitoring using an ECG-DONGLE electrocardiograph in patients suffering from chronic heart failure. Vestnik Rossiiskoi Voenno-meditsinskoi akademii. 2021;23(4):71–8. (In Russ.)]. doi: 10.17816/brmma63710.
  18. Carnicelli A.P., et al. Atrial fibrillation and clinical outcomes 1 to 3 years after myocardial infarction. Open Heart. 2021;8(2):e001726. doi: 10.1136/openhrt-2021-001726.
  19. Свеклина Т.С. и др. Особенности электрокардиографических и ультразвуковых показателей гипертрофии левого желудочка у больных артериальной гипертензией в сочетании с сахарным диабетом 2 типа и фибрилляцией предсердий. Профилактическая и клиническая медицина. 2011;2–2(39). [Sveklina T.S. Features of electrocardiographic and ultrasound parameters of left ventricular hypertrophy in patients with arterial hypertension in combination with type 2 diabetes mellitus and atrial fibrillation. Profilakticheskaya i klinicheskaya meditsina. 2011;2–2(39). (In Russ.)].
  20. Максим О.В., Салухов В.В. От нарушений пищевого поведения к ожирению: вопросы диагностики и нейроэндокринной регуляции. Consilium Medicum. 2022;24(4):234–41. [Maxim O.V., Salukhov V.V. From eating disorders to obesity: issues of diagnosis and neuroendocrine regulation. Consilium Medicum. 2022;24(4):234–41. (In Russ.)]. doi: 10.26442/20751753.2022.4.201543.
  21. Аметов А.С. и др. Устранение дисфункции жировой ткани как главный фактор снижения кардиометаболических рисков при ожирении. Терапия. 2019;5(6/32):66–74. Ametov A.S. Elimination of dysfunction of adipose tissue as the main factor in reducing cardiometabolic risks in obesity. Terapia=Therapy. 2019;5(6/32):66–74. (In Russ.)]. doi: 10.18565/therapy.2019.6.66-74.
  22. Carna Z., Osmancik P. The Effect of Obesity, Hypertension, Diabetes Mellitus, Alcohol, and Sleep Apnea on the Risk of Atrial Fibrillation. Physiol Res. 2021;70(Suppl. 4):S511–25. doi: 10.33549/physiolres.934744.
  23. Салухов В.В., Кадин Д.В. Ожирение как фактор онкологического риска. Обзор литературы. Медицинский совет. 2019;4:94–102. [Salukhov V.V., Kadin D.V. Obesity as a cancer risk factor. Literature review. Meditsinskii sovet. 2019;4:94–102. (In Russ.)]. doi: 10.21518/2079-701X-2019-4-94-102.
  24. Halcox J.P.J., et al. Assessment of Remote Heart Rhythm Sampling Using the AliveCor Heart Monitor to Screen for Atrial Fibrillation: The REHEARSE-AF Study. Circulation. 2017;136(19):1784–94. doi: 10.1161/CIRCULATIONAHA.117.030583.
  25. Guo Y., et al. Population-Based Screening or Targeted Screening Based on Initial Clinical Risk Assessment for Atrial Fibrillation: A Report from the Huawei Heart Study. J Clin Med. 2020;9(5):1493. doi: 10.3390/jcm9051493.
  26. Yan B.P., et al. High-Throughput, Contact-Free Detection of Atrial Fibrillation From Video With Deep Learning. JAMA. Cardiol. 2020;5(1):105. 10.1001/jamacardio.2019.4004.
  27. Kornej J., et al. Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methods and New Insights. Circ. Res. 2020;127(1):4–20. doi: 10.1161/CIRCRESAHA.120.316340.
  28. Jones N.R., et al. Screening for atrial fibrillation: a call for evidence. Eur Heart J. 2020;41(10):1075–85. doi: 10.1093/eurheartj/ehz834.
  29. Dey D., et al. Artificial Intelligence in Cardiovascular Imaging. J Am Coll Cardiol. 2019;73(11):1317–35. doi: 10.1016/j.jacc.2018.12.054.
  30. Attia Z.I., et al. An artificial intelligence-enabled ECG algorithm for the identification of patients with atrial fibrillation during sinus rhythm: a retrospective analysis of outcome prediction. Lancet. 2019;394(10201):861–67. doi: 10.1016/S0140-6736(19)31721-0.
  31. Boriani G., et al. Consumer-led screening for atrial fibrillation using consumer-facing wearables, devices and apps: A survey of health care professionals by AF-SCREEN international collaboration. Eur J Intern Med. 2020;82:97–104. doi: 10.1016/j.ejim.2020.09.005.
  32. Chen W. et al. Cost-effectiveness of Screening for Atrial Fibrillation Using Wearable Devices. JAMA. Health Forum. 2022;3(8):e222419. doi: 10.1001/jamahealthforum.2022.2419.
  33. Diederichsen S.Z., et al. Incidence and predictors of atrial fibrillation episodes as detected by implantable loop recorder in patients at risk: From the LOOP study. Am Heart J. 2020;219:117–27. doi: 10.1016/j.ahj.2019.09.009.
  34. Bettin M., et al. Extended ECG monitoring with an implantable loop recorder in patients with cryptogenic stroke: time schedule, reasons for explantation and incidental findings (results from the TRACK-AF trial). Clin Res Cardiol. 2019;108(3):309–14. doi: 10.1007/s00392-018-1358-4.
  35. Tajrishi F.Z., et al. Smartwatch for the Detection of Atrial Fibrillation. Crit Pathw Cardiol J Evid.-Based Med. 2019;18(4):176–84. doi: 10.1097/HPC.0000000000000192.
  36. Brandes A., et al. Consumer-Led Screening for Atrial Fibrillation: Frontier Review of the AF-SCREEN International Collaboration. Circulation. 2022;146(19):1461–74. Doi: org/10.1161/CIRCULATIONAHA.121.05891.1
  37. Aras D., et al. Understanding the Burden of Atrial Fibrillation and Importance of Screening: A Global Perspective and Recommendations for Turkey. Anatol J Cardiol. 2022;26(9):673–84. doi: 10.5152/AnatolJCardiol.2022.1689.
  38. Brasier N., et al. Detection of atrial fibrillation with a smartphone camera: first prospective, international, two-centre, clinical validation study (DETECT AF PRO). EP Eur. 2019;21(1):41–7. doi: 10.1093/europace/euy176.
  39. Chang P.-C., et al. Atrial Fibrillation Detection Using Ambulatory Smartwatch Photoplethysmography and Validation with Simultaneous Holter Recording. Am Heart J. 2022;247:55–62. doi: 10.1016/j.ahj.2022.02.002.
  40. Saliba W., et al. Usefulness of CHADS2 and CHA2DS2-VASc Scores in the Prediction of New-Onset Atrial Fibrillation: A Population-Based Study. Am. J. Med. 2016;129(8):843–49. doi: 10.1016/j.amjmed.2016.02.029.
  41. Perez M.V., et al. Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation. N Engl J Med. 2019;381(20):1909–17. doi: 10.1056/NEJMoa1901183.
  42. Wyatt K.D.Ю., et al. Clinical evaluation and diagnostic yield following evaluation of abnormal pulse detected using Apple Watch. J Am Med Inform. Assoc. 2020;27(9):135963. doi: 10.1093/jamia/ocaa137.
  43. Bauer. Smartphone AF Screening Doubles Detection: eBRAVE-AF [Электронный ресурс]. URL: https://www.medscape.com/viewarticle/980713 (access date: 25.09.2022).
  44. Вишнякова Н.А., Янин В.А., Копылов Ф.Ю. Распространенность фибрилляции предсердий по данным метода одноканальной электрокардиографии с дистанционной передачей данных. Современная наука, актуальные проблемы теории и практики. Серия: Естественные и технические науки. 2019;8:154–61. [Vishnyakova N.A., Yanin V.A., Kopylov F.Yu. The prevalence of atrial fibrillation according to the method of single-channel electrocardiography with remote data transmission. Sovremennaya nauka, aktual’nye problemy teorii i praktiki. Seriya: Estestvennye i tekhnicheskie nauki. 2019;8:154–61. (In Russ.)].
  45. Cardiac Designs Inc. ECG Check [Electronic resource]. URL: https://www.cardiacdesigns.com
  46. Bumgarner J.M., et al. Smartwatch Algorithm for Automated Detection of Atrial Fibrillation J Am Coll Cardiol. 2018;71(21):2381–88. doi: 10.1016/j.jacc.2018.03.003.
  47. Bacchini M., et al. Opportunistic Screening for Atrial Fibrillation in the Pharmacies: A Population-Based Cross-Sectional Study. High Blood Press. Cardiovasc Prev. 2019;26(4):339–44. doi: 10.1007/s40292-019-00334-4.
  48. University of California, San Francisco. Coffee and Real-time Atrial and Ventricular Ectopy University of California, San Francisco. clinicaltrials.gov, 2021.
  49. Lubitz S.A. Detection of atrial fibrillation in a large population using wearable devices: the Fitbit Heart Study [Electronic resource]. (Access date: 15.12.2021).
  50. Al-Alusi M.A., et al. Wearing Your Heart on Your Sleeve: the Future of Cardiac Rhythm Monitoring. Curr Cardiol Rep. 2019;21(12):158. doi: 10.1007/s11886-019-1223-8.
  51. Kwon S., et al. Comparison Between the 24-hour Holter Test and 72-hour Single-Lead Electrocardiogram Monitoring With an Adhesive Patch-Type Device for Atrial Fibrillation Detection: Prospective Cohort Study. J Med Internet Res. 2022;24(5):e37970. doi: 10.2196/37970.
  52. Steinhubl S.R., et al. Effect of a Home-Based Wearable Continuous ECG Monitoring Patch on Detection of Undiagnosed Atrial Fibrillation: The mSToPS Randomized Clinical Trial. JAMA. 2018;320(2):146. doi: 10.1001/jama.2018.8102.
  53. Validation of the Firstbeat TeamBelt and BodyGuard2 systems. PDF Free Download [Electronic resource]. URL: https://adoc.pub/validation-of-the-firstbeat-teambelt-and-bodyguard2-systems.html (access date: 13.01.2022).
  54. Xintarakou A., et al. Remote Cardiac Rhythm Monitoring in the Era of Smart Wearables: Present Assets and Future Perspectives. Front Cardiovasc Med. 2022;9:853614. doi: 10.3389/fcvm.2022.853614.

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