Screening of atrial fibrillation episode in patients with abnormal echocardiographic parameters

Abstract Background Atrial fibrillation (AF) is the most common arrhythmia, and proper management can improve prognosis. However, AF can be paroxysmal and asymptomatic, causing delayed diagnosis. Although AF screening is important, the best strategy remains unclear. Methods We enrolled 118 patients, aged 66.1 ± 15.3 years without AF but with abnormal echocardiography parameters, for 7-day continuous single-strip ECG monitoring. The criteria included LA enlargement, LVH, E/e’ 14, grade II/III diastolic dysfunction, VHD, or HF. Patients received a 30-second ECG recording and 7-day ECG monitoring at enrollment and at three, six, nine, and twelve months follow-up. (Figure 1) The endpoint was the detection of AF. Results Out of 118 enrollees, 57 met the HF criterion, 54 met the LAE criterion, 26 met the LVH criterion, 47 met the E/e’ criterion, 34 met the diastolic dysfunction criterion, and 15 met the VHD criterion. Criteria categories were not mutually exclusive; patients could meet multiple criteria. Hypertension was the most common comorbidity (55.1%), followed by CKD (40.7%) and HF (39%). AF was detected in 14 patients (11.9%) through 7-day ECG recordings, not 12-lead ECGs, with 12 patients receiving oral anticoagulants for stroke prevention. AF was found in 7 patients during the first 7-day ECG, 3 at the 3rd month, 2 at the 6th month, and 2 at the 9th month. Among these 14 patients, AF appeared in four recordings for one patient, two recordings for five patients, and one recording for eight patients. The rates of incident AF for each criteria group were as follows: 5.3% for HF, 20.4% for LAE, 7.7% for LVH, 23.4% for E/e’, 20.6% for diastolic dysfunction, and 6.7% for VHD. (Figure 2) Detection rates were also calculated by analyzing patients who met combinations of two different criteria. The "LAE + E/e’" group had the highest rate of incident AF at 32%, followed by the "HF + E/e’", "LAE + diastolic dysfunction," "LVH + VHD," and "E/e’ + diastolic dysfunction" groups, each with approximately 20%. The "HF + LVH" and "HF + VHD" subgroups showed no detection of AF. Conclusions Extended ECG monitoring effectively detects AF in patients with abnormal echocardiographic parameters, especially those with elevated E/e’, LAE, or diastolic dysfunction, supporting targeted monitoring to improve AF diagnosis.Study protocol AF detection in different groups