Prevalence and characteristics of subclinical atrial fibrillation in a community-dwelling elderly population: The ARIC study

Mary R. Rooney, Elsayed Z. Soliman, Pamela L. Lutsey, Faye L. Norby, Laura R. Loehr, Thomas H. Mosley, Michael Zhang, Rebecca F. Gottesman, Josef Coresh, Aaron R. Folsom, Alvaro Alonso, Lin Y. Chen

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Article numbere007390
JournalCirculation: Arrhythmia and Electrophysiology
Volume12
Issue number10
DOIs
StatePublished - Oct 1 2019

Keywords

  • atrial fibrillation
  • elderly
  • electrocardiography
  • prevalence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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