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Prevalence and Characteristics of Subclinical Atrial Fibrillation in a Community-Dwelling Elderly Population: The ARIC Study.

TitlePrevalence and Characteristics of Subclinical Atrial Fibrillation in a Community-Dwelling Elderly Population: The ARIC Study.
Publication TypeJournal Article
Year of Publication2019
AuthorsRooney MR, Soliman EZ, Lutsey PL, Norby FL, Loehr LR, Mosley TH, Zhang M, Gottesman RF, Coresh JJ, Folsom AR, Alonso A
Secondary AuthorsChen LYee
JournalCirc Arrhythm Electrophysiol
Volume12
Issue10
Paginatione007390
Date Published2019 10
ISSN1941-3084
KeywordsAged, Aged, 80 and over, Atrial Fibrillation, Cross-Sectional Studies, Electrocardiography, Female, Follow-Up Studies, Humans, Independent Living, Male, Middle Aged, Prevalence, Retrospective Studies, Risk Factors, United States
Abstract

BACKGROUND: The prevalence of subclinical atrial fibrillation (AF) in the elderly general population is unclear. We sought to define the prevalence of subclinical AF in a community-based elderly population and to characterize subclinical AF and the incremental diagnostic yield of 4 versus 2 weeks of continuous ECG monitoring.

METHODS: We conducted a cross-sectional analysis within the community-based multicenter observational ARIC study (Atherosclerosis Risk in Communities) using visit 6 (2016-2017) data. The 2616 ARIC study participants who wore a leadless, ambulatory ECG monitor (Zio XT Patch) for up to 2 weeks were aged 79±5 years, 42% men, and 26% black. In a subset, 386 participants without clinically recognized AF wore the monitor twice, each time for up to 2 weeks. We characterized the prevalence of subclinical AF (ie, AF detected on the Zio XT Patch without clinically recognized AF) over 2 weeks of monitoring and the diagnostic yield of 4 versus 2 weeks of monitoring.

RESULTS: The prevalence of subclinical AF was 2.5%; the prevalence of subclinical AF was 3.3% among white men, 2.5% among white women, 2.1% among black men, and 1.6% among black women. Subclinical AF was mostly intermittent (75%). Among those with intermittent subclinical AF, 91% had AF burden ≤10% during the monitoring period. In a subset of 386 participants without clinical AF, 78% more subclinical AF was detected by 4 weeks versus 2 weeks of ECG monitoring.

CONCLUSIONS: In our study, the prevalence of subclinical AF was lower than previously reported and monitoring beyond 2 weeks provided substantial incremental diagnostic yield. Future studies should focus on individuals with higher risk to increase diagnostic yield and consider continuous monitoring duration longer than 2 weeks.

DOI10.1161/CIRCEP.119.007390
Alternate JournalCirc Arrhythm Electrophysiol
PubMed ID31607148
PubMed Central IDPMC6814387
Grant List16EIA26410001 / AHA / American Heart Association-American Stroke Association / United States
HHSN268201700001I / HL / NHLBI NIH HHS / United States
HHSN268201700004I / HL / NHLBI NIH HHS / United States
HHSN268201700004C / HL / NHLBI NIH HHS / United States
HHSN268201700003I / HL / NHLBI NIH HHS / United States
R01 HL126637 / HL / NHLBI NIH HHS / United States
T32 HL007779 / HL / NHLBI NIH HHS / United States
HHSN268201700002C / HL / NHLBI NIH HHS / United States
HHSN268201700005C / HL / NHLBI NIH HHS / United States
HHSN268201700001C / HL / NHLBI NIH HHS / United States
HHSN268201700003C / HL / NHLBI NIH HHS / United States
R01 HL141288 / HL / NHLBI NIH HHS / United States
HHSN268201700002I / HL / NHLBI NIH HHS / United States
HHSN268201700005I / HL / NHLBI NIH HHS / United States