Key result
Prolonged Holter monitoring detects subclinical AF in ~16% of older CVD outpatients.
Why the study?
Detecting subclinical/silent atrial fibrillation is critical due to potential adverse consequences, but its prevalence in the general population may be lower than in device patients and required assessment.
Does prolonged ECG Holter monitoring detect subclinical atrial fibrillation in older outpatients at risk for AF?
Observational (n=119)
Yes
Does prolonged ECG Holter monitoring detect subclinical atrial fibrillation in older outpatients at risk for AF?
Prolonged ECG Holter monitoring is an effective strategy for detecting subclinical atrial fibrillation in at-risk older adults, identifying previously unrecognized arrhythmias in 16% of patients.
Supports extended monitoring to uncover subclinical AF in older outpatients; leaves open whether detection warrants intervention or improves outcomes.
Background: The detection of subclinical/silent atrial fibrillation (SAF) in the general population is of the utmost importance, given its potential adverse consequences. Incident AF has been observed in 30% to 70% of patients with implanted devices, but its prevalence may indeed be lower in the general population. The prospective, multicentric, observational Silent Atrial Fibrillation ANCE Research Initiative (SAFARI) study aimed at assessing the SAF prevalence in a real-world outpatient setting by the means of a small, wearable, prolonged ECG Holter monitoring (>5 days) device (CGM HI 3-Lead ECG; CGM TELEMEDICINE, Piacenza, Italy). Methods: Patients ≥ 55 years of age at risk for AF were screened according to the inclusion criteria to undergo prolonged 3-lead ECG Holter monitoring. SAF episodes were classified as follows: Class A, <30 s; Class B, 30 to 299 s; and Class C, ≥300 s. Results: In total, 119 patients were enrolled (64 men; median age 71 (IQR 55–85) years). At a median of 13.5 (IQR 5–21) days of monitoring, SAF episodes were found in 19 patients (16%). A total of 10,552 arrhythmic episodes were registered, 6901 in Class A (n = 7 patients), 2927 in Class B (n = 3), and 724 in Class C (n = 9), (Class A vs. B and C, p < 0.001). This latter group had multiple (all-class) episodes, and two patients had >1000 episodes. There were no clinical, echocardiographic, or laboratory findings able to discriminate patients with SAF from those in sinus rhythm in univariate and multivariable analyses; of note is that the Class C patients showed a higher diastolic blood pressure, resting heart rate, and indexed LA volume. Conclusions. Over a median of 13 days of Holter monitoring, the SAFARI study confirmed the usefulness of small wearable devices in detecting SAF episodes in real-world outpatients at risk for, but with no prior history of, AF.
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Gregorio et al. (2023) conducted an observational in At risk for atrial fibrillation (n=119). Prolonged ECG Holter monitoring was evaluated on Detection of subclinical/silent atrial fibrillation (SAF). Prolonged ECG Holter monitoring detected subclinical atrial fibrillation in 16% of older outpatients with cardiovascular disease but no prior history of the arrhythmia.
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