RECOGNIZING SILENT ATRIAL FIBRILLATION IN A HIGH-RISK POPULATION

Therapeutic Area

Preventive Cardiology Best Practices – clinic operations, team approaches, outcomes research

Background

Silent atrial fibrillation (AF) is a major risk factor for stroke, heart failure, and cognitive decline, often remaining undiagnosed until a thromboembolic event occurs. Standard 12-lead ECG and 24-hour Holter monitoring frequently miss paroxysmal episodes. Prolonged ECG monitoring (≥7 days) improves detection rates, yet its clinical implementation remains limited. This study evaluates AF detection rates across various monitoring durations in a high-risk population.

Methods

This retrospective study analyzed patients aged ≥65 years with CHA₂DS₂-VASc ≥2 who underwent 12-lead ECG, 24-hour Holter, 7-day, 14-day, or 30-day patch ECG monitoring at a single center from January 2023 to December 2023. The primary endpoint was silent AF detection rate, comparing different monitoring modalities. The secondary outcome was the proportion of newly diagnosed AF patients eligible for anticoagulation.

Results

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  12-lead ECG: Detected AF in 4%of high-risk patients.
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  24-hour Holter: Identified 12%, missing intermittent episodes.
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  7-day Patch ECG: Improved detection to 23%.
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  14-day Patch ECG: Further increased yield to 29%.
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  30-day Patch ECG: Provided the highest detection at 34%.
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  Clinical Impact: 82% of newly diagnosed silent AF patients met anticoagulation criteria, reinforcing the need for early intervention.

Conclusions

Silent AF is significantly underdiagnosed, and longer monitoring durations correlate with higher detection rates. Short-term ECG and Holter monitoring are insufficient, while 30-day patch ECG provides the highest diagnostic yield. These findings support routine ≥14-day ECG monitoring for high-risk individuals. Wearable ECG and AI-based arrhythmia detection tools may further enhance early diagnosis, guiding timely anticoagulation therapy and stroke prevention.