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August 7, 2018

Electrocardiographic Monitoring for Prevention of Atrial Fibrillation–Associated Cardioembolic Stroke

Author Affiliations
  • 1University of Miami Miller School of Medicine, Miami, Florida
JAMA. 2018;320(5):447-449. doi:10.1001/jama.2018.9185

Screening appropriate populations for atrial fibrillation has become an important clinical question, because cardioembolic stroke may be the first clinical manifestation of atrial fibrillation. In this issue of JAMA, the US Preventive Services Task Force (USPSTF) provides its Recommendation Statement on screening for atrial fibrillation with electrocardiography (ECG),1 based on a detailed review of the evidence.2,3 For a substantial number of patients, atrial fibrillation may first be diagnosed concurrent with the stroke or in follow-up.4-6 Given the known association of atrial fibrillation with stroke and that anticoagulation can prevent up to 80% of strokes in patients with clinical nonvalvular atrial fibrillation, it has been postulated that screening high-risk, asymptomatic populations can identify patients with atrial fibrillation for whom anticoagulation can be initiated to prevent thromboembolic complications. The USPSTF report highlights that although ongoing studies are evaluating this hypothesis, there is no current evidence to support it. Accordingly, the task force “concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for atrial fibrillation with ECG (I statement).”1