Atrial Fibrillation Screening

Abstract

Atrial fibrillation (AF) is the most common arrhythmia resulting in the burden of healthcare. Screening for AF can lead to stroke prevention with oral anticoagulants in selected patients. Opportunistic screening for AF should be performed in people aged ≥65 years by pulse palpation. Systematic screening for AF should be introduced in people aged ≥75 years or those at high risk for ischemic stroke. Patients with cardiac implantable electronic devices who have atrial high-rate episodes (AHREs) should be further investigated for the diagnosis of AF. Oral anticoagulant should be prescribed if AHREs ≥5.5 hours in patients with a high risk of ischemic stroke (CHA₂DS₂-VASc score >1 in males or >2 in females). AF screening following ischemic stroke should be done with pulse palpation and 12-lead electrocardiography, as well as ECG monitoring for 24-72 hours to increase the chance of detecting AF. The devices with new technologies are promising tools for AF screening with ease. Even though AF screening is cost-effective, higher costs for more investigation and treatment are often a concern after AF diagnosis. The appropriate strategy for AF screening in Thailand should be investigated for the cost-effectiveness.