Recent years have seen significant advances in knowledge about the prevalence of ‘silent’ atrial fibrillation and the morbidity associated with this condition. Data are emerging on improved strategies for screening, and new technologies for detecting atrial fibrillation are becoming available, making a review of this field timely.
Studies suggest that, when screening is performed, undiagnosed atrial fibrillation is present in around 1% of the screened population, rising to 1.4% for those aged at least 65 years. The prevalence of silent atrial fibrillation is even higher in patients with additional risk factors (e.g. those aged 75 years, patients with heart failure). Prolonged monitoring of patients with hypertension and an implanted cardiac device showed subclinical atrial arrhythmias in at least 10% and these patients had a 2.5-fold increased risk of stroke or systemic embolism. The feasibility of screening for silent atrial fibrillation has been demonstrated in a number of populations and many new technologies for atrial fibrillation detection exist, which could improve the efficiency and cost-effectiveness of this process.
Increased attention is being directed towards screening for silent atrial fibrillation and our ‘toolbox’ for detecting it is expanding. Whether this will translate into improved outcomes for patients remains to be proven.
aLibin Cardiovascular Institute of Alberta, Calgary, Alberta
bSunnybrook Health Sciences Centre, Division of Neurology, Department of Medicine, University of Toronto, and University of Toronto Stroke Program, Toronto, Ontario, Canada
Correspondence to Dr F. Russell Quinn, BA, BM, BCh, MRCP, PhD, Libin Cardiovascular Institute of Alberta, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada. Tel: +1 403 220 5500; e-mail: firstname.lastname@example.org