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Pulse palpation and history of palpitations in atrial fibrillation screening - preliminary results from the strokestop 2 study

Session Poster Session 7

Speaker Doctor Katrin Kemp Gudmundsdottir

Event : ESC Congress 2018

  • Topic : arrhythmias and device therapy
  • Sub-topic : Diagnostic Methods
  • Session type : Poster Session

Authors : K Kemp Gudmundsdottir (Stockholm,SE), E Svennberg (Stockholm,SE), F Al-Khalili (Stockholm,SE), T Fredriksson (Stockholm,SE), V Frykman (Stockholm,SE), L Friberg (Stockholm,SE), M Rosenqvist (Stockholm,SE), J Engdahl (Stockholm,SE)

K. Kemp Gudmundsdottir1 , E. Svennberg1 , F. Al-Khalili1 , T. Fredriksson1 , V. Frykman1 , L. Friberg2 , M. Rosenqvist1 , J. Engdahl1 , 1Danderyd University Hospital - Stockholm - Sweden , 2Karolinska Institute - Stockholm - Sweden ,

Atrial Fibrillation - Diagnostic Methods

European Heart Journal ( 2018 ) 39 ( Supplement ), 1422

Background: Atrial fibrillation (AF) is significant risk-factor for embolic ischemic stroke, with a prevalence that increases with age and often an asymptomatic presentation. The ESC AF guidelines recommend opportunistic screening for AF by pulse taking in patients >65 years of age.

Purpose: We aimed at comparing one-lead ECG with pulse palpation in a systematic AF screening program, and in addition find if symptomatic patients were more likely to be diagnosed with AF.

Methods: All 75/76-year old individuals in the Stockholm region (n=28,712) were randomised to an AF screening program invitation or to serve as a control group. Palpation of the radial pulse was performed for 30 seconds in all participants free of AF and classified as regular vs. irregular before a one-lead ECG was taken for comparison. In addition, participants reported symptoms of palpitations.

Results: In total, 6150 of 6696 participants were included, the remainder had previously known AF. Irregular pulse was detected in 7.6% (465/6150), of whom 26 were confirmed having AF on one-lead ECG. Among 5685 participants with regular pulse, 6 were diagnosed with AF on a one-lead ECG, resulting in a sensitivity of 0,81 (95% CI: 0.63–0.93) and a specificity of 0,92 (CI: 0.92–0.93), positive predictive value 0,06 (CI: 0.05–0.07) and negative predictive value 1.00 (CI: 1.00–1.00). In 1826 participants reporting palpitations, 47 (2,6%) were diagnosed with AF on either index-ECG or during 2 weeks of screening whereas 89 (2,1%) of 4288 participants without palpitations were diagnosed with AF.

Conclusions: Pulse palpation, as recommended by ESC-guidelines has a very low positive predictive value resulting in a high proportion of false positive results. Sensitivity for pulse palpation was modest. Palpitations were not associated with AF diagnosis during screening.

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