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JAMA Patient Page
August 7, 2018

Screening for Atrial Fibrillation With Electrocardiography

JAMA. 2018;320(5):516. doi:10.1001/jama.2018.10598

The US Preventive Services Task Force (USPSTF) has recently published recommendations on screening for atrial fibrillation using electrocardiography.

What Is Atrial Fibrillation?

Atrial fibrillation is a type of irregular heartbeat (arrhythmia). It is the most common arrhythmia in adults, and the chance of having atrial fibrillation increases with age. Although some people have symptoms such as heart palpitations or shortness of breath, many people with atrial fibrillation do not have symptoms and do not know that they have it. Atrial fibrillation increases the risk of stroke, and often people are diagnosed as having atrial fibrillation because they had a stroke. Treatment for atrial fibrillation involves medications to keep the heart from beating too quickly as well as blood thinners to prevent stroke in some people. More invasive procedures can also be done to stop irregular heartbeats.

There are several ways that atrial fibrillation can be found, such as listening to the heart with a stethoscope, taking the pulse, or performing an electrocardiogram (ECG). An ECG is a test that detects electrical activity in the heart using sensors that are placed on the skin over the chest. It is a quick, painless test than can be done in a doctor’s office.

What Is the Patient Population Under Consideration for Screening for Atrial Fibrillation with ECG?

This USPSTF recommendation applies to adults aged 65 years or older who do not have symptoms of atrial fibrillation.

What Are the Potential Benefits and Harms of Screening for Atrial Fibrillation with ECG?

The potential benefit of finding atrial fibrillation earlier in people with no symptoms is starting treatment earlier, particularly for stroke prevention, which could potentially avoid major disability and death. Potential harms include unnecessary treatment or overtreatment, which can have major side effects such as bleeding caused by blood thinners or complications from more invasive heart procedures. There are currently no studies looking at clinical outcomes of screening programs for atrial fibrillation using ECG. There are also no trials looking at the benefit of treating atrial fibrillation in persons with screening-detected atrial fibrillation.

How Strong Is the Recommendation to Screen for Atrial Fibrillation with ECG?

For older adults with no symptoms, the USPSTF concludes that current evidence is insufficient to assess the balance of benefits and harms of using ECG (in addition to routine physical examination that involves checking the heart rate and listening to the heart) to screen for atrial fibrillation.

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Article Information

Source: US Preventive Services Task Force. Screening for atrial fibrillation with electrocardiography: US Preventive Services Task Force recommendation statement [published August 7, 2018]. JAMA. doi:10.1001/jama.2018.10321

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