What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Atrial fibrillation (n=694). Intervention: Opportunistic 12-lead ECG screening. Primary outcome: Prevalence of atrial fibrillation on 12-lead ECG.

February 20, 2025Frontiers in Cardiovascular Medicine10 citationsOpen Access

Atrial fibrillation screening in Syrian patients reporting to the emergency department during the ongoing conflict: a cross-sectional study

IAIbrahim Antoun AAAlkassem Alkhayer AEAref Jalal Eldin

Key Result

Opportunistic 12-lead ECG screening in a Syrian emergency department detected atrial fibrillation in 15% of patients, with congestive cardiac failure and higher CHA2DS2-VASc scores independently predicting its presence.

Study Design

Type

Cross-Sectional (n=694)

Multicenter

Structured PICO

Population

694 patients >40 years old reporting to the emergency department of a Syrian tertiary centre (Tishreen’s University Hospital, Latakia) between July 2024 and September 2024. Median age 61, 52% male. Excluded critically unwell patients, those with hemodynamic instability, and those with discrepancies in ECG diagnosis between consultants.

Intervention

Routine 12-lead electrocardiogram (ECG) screening regardless of presenting complaint

Outcome

Prevalence of atrial fibrillation (AF) in patients presenting to the emergency department

Routine 12-lead ECG screening in a Syrian emergency department revealed a high 15% prevalence of atrial fibrillation, with congestive cardiac failure and higher CHA₂DS₂-VASc scores acting as independent predictors.

Limitations

Data collection was limited to a single tertiary care centre in Latakia, which may not be generalisable to other regions.
Analysis included only routinely collected data within medical records.
Single ECG screening might have missed paroxysmal and subclinical AF, potentially underestimating prevalence.
Study duration was limited to three months, which may have introduced seasonal biases in patient presentations.

Abstract

Background Atrial fibrillation (AF) is the most common arrhythmia worldwide. Data regarding AF screening in conflict countries’ emergency departments (ED) is lacking. Methods We included consecutive patients 40 years old who reported to the ED of a Syrian tertiary centre between July 2024 and September 2024. Patients had routine 12-lead electrocardiograms (ECGs) regardless of presenting complaints. Two cardiology consultants blindly verified ECG findings. We excluded critically unwell patients and ECG discrepancies between the two consultants. Data were taken from patients’ medical notes. Results The final analysis included 694 patients, 101 (15%) had AF on the ECG. The most common presenting complaints and ECG abnormality were trauma (44%) and sinus tachycardia (15%), respectively. Compared to the rest of the patients, AF patients were older (66 vs. 59 years; p 0.001), had a lower proportion of males (39% vs. 54%; p = 0.01), a higher prevalence of diabetes mellitus (49% vs. 21%; p = 0.01), and more cases of congestive cardiac failure (CCF) (38% vs. 17%; p 0.001). AF patients also had a higher CHA ₂ DS ₂ -VASc score (3 vs. 2; p 0.001). CCF odds ratio [OR: 3.3, 95% confidence interval CI: 1.5–6.4, p 0.001] and a higher CHA₂DS₂-VASc score(OR: 4, 95% CI: 1.6–7.7, p 0.001) were independently associated with positive AF screening. Conclusion 15% of patients reporting to this Syrian ED had positive AF screening. CCF and CHA₂DS₂-VASc scores are predictive of AF.

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