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Background  Identification of silent atrial fibrillation ( AF ) could prevent stroke and other sequelae.    Hypothesis  Screening for  AF  using continuous ambulatory electrocardiographic ( ECG ) monitoring can detect silent  AF  in asymptomatic in patients with known risk factors.    Methods  We performed a single‐center prospective screening study using a wearable patch‐based device that provides up to 2 weeks of continuous ambulatory  ECG  monitoring ( iRhythm  Technologies, Inc.). Inclusion criteria were age ≥55 years and ≥2 of the following risk factors: coronary disease, heart failure, hypertension, diabetes, sleep apnea. We excluded patients with prior  AF , stroke, transient ischemic attack, implantable pacemaker or defibrillator, or with palpitations or syncope in the prior year.    Results  Out of 75 subjects (all male, age 69 ± 8.0 years; ejection fraction 57% ± 8.7%),  AF  was detected in 4 subjects (5.3%;  AF  burden 28% ± 48%). Atrial tachycardia ( AT ) was present in 67% (≥4 beats), 44% (≥8 beats), and 6.7% (≥60 seconds) of subjects. The combined diagnostic yield of sustained  AT / AF  was 11%. In subjects without sustained  AT / AF , 11 (16%) had ≥30 supraventricular ectopic complexes per hour.    Conclusions  Outpatient extended  ECG  screening for asymptomatic  AF  is feasible, with  AF  identified in 1 in 20 subjects and sustained  AT / AF  identified in 1 in 9 subjects, respectively. We also found a high prevalence of asymptomatic  AT  and frequent supraventricular ectopic complexes, which may be relevant to development of  AF  or stroke. If confirmed in a larger study, primary screening for  AF  could have a significant impact on public health.

clinical cardiology

Feasibility of Extended Ambulatory Electrocardiogram Monitoring to Identify Silent Atrial Fibrillation in High‐risk Patients: The Screening Study for Undiagnosed Atrial Fibrillation ( STUDY‐AF )