Seek and You Will Find Atrial Fibrillation

Atrial fibrillation (AF), whether symptomatic or not, is a significant cause of morbidity and mortality. Long-term monitoring of patients with a first diagnosis of cryptogenic stroke has demonstrated that a significant percentage have undiagnosed AF (NEJM JW Cardiol Aug 2014 and N Engl J Med 2014; 370:2478). Whether high prevalence of asymptomatic and undiagnosed AF extends to other populations is not clear.

The partly industry-funded ASSERT 2 trial tested the question of whether high-risk individuals have subclinical AF. Patients aged ≥65 without history of AF but with high AF risk (CHA₂DS₂-VASc score ≥2, sleep apnea, or body-mass index >30) were implanted with subcutaneous electrocardiographic monitors. Enrollees also had to have left atri…