Atrial fibrillation (AF) remains the most common cardiac arrhythmia, associated with a fivefold increased risk of stroke, as well as an increased risk for heart failure. The management of AF encompasses screening and diagnosis, improvement of quality of life through rate or rhythm control, reduction of morbidity and mortality through prevention of stroke and systemic thromboembolism, as well as treatment of associated conditions. Early detection may mitigate complications through prompt intervention. Unfortunately, AF is often unrecognized and untreated because it is frequently asymptomatic or minimally symptomatic and often paroxysmal.

Both the CCS/CHRS and ESC guidelines advocate opportunistic screening for AF in people ≥ 65 years of age at the time of an unrelated medical encounter. The rationale for these recommendations is based on a combination of effectiveness (the AF detection rate for persons ≥ 65 years has been reported as 1.44% (95% confidence interval [CI], 1.13%-1.82%] vs 0.41% [95% CI, 0.31%-0.53%] in persons < 65 years of age), and the actionable outcomes (ie, patients ≥ 65 years of age with AF indicate oral anticoagulation [OAC] therapy for stroke prevention). In addition, the ESC guidelines recommend systematic screening for patients with higher risk of stroke (CHA2DS2-VA scores ≥ 2), largely based on the 4-fold increase in detection of AF in the Systematic ECG Screening for Atrial Fibrillation Among 75- Year-Old Subjects in the Region of Stockholm and Halland, Sweden (STROKESTOP) study, in which new AF was detected in 3.0% (95% CI, 2.7%-3.5%) of patients participating in a 2-week screening program compared with an index electrocardiogram (ECG) alone.

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