![]() ![]() This is a standard oscillometric BP device that uses pulse wave irregularity to diagnose AF. There is no diagnosis or ECG trace on the device, which transmits wirelessly via the mobile network to a central data base with arrhythmia detection of ECG traces, viewable by the physician. Thumbs of each hand placed on the gray button electrodes on each side for 30 seconds generate a lead 1 ECG. #Cardiograph app shows irregular heartbeat PcThe device can be connected by a cable to a PC to view the recordings, which have a date and time stamp only. After recording for 1 minute, a green light indicates normal rhythm, a red light AF. Top left, MyDiagnostick, which is a bar activated when held by left and right hands (lead 1 ECG). Other devices to screen for atrial fibrillation. This is the principle behind a number of popular mobile devices and apps used to measure heart rate, primarily for exercise and fitness.įigure 1. The app uses the smartphone flash/lightsource and camera to obtain a photoplethysmographic (PPG) recording of the pulse wave. 2, 12 In this context it is interesting to see the contribution of Chan et al 13 in this issue of the Journal of the American Heart Association evaluating the diagnostic performance of a smartphone app. The advent of small devices that can diagnose AF automatically, based on either pulse irregularity 8, 9 or rhythm analysis of a single‐lead handheld ECG, 4, 10, 11 could change the cost‐benefit equation in favor of a more systematic approach to screening for AF either in the clinic or in the community ( Figure). 6 Unfortunately, pulse taking is not commonly performed in general practice, and if the heart rate is recorded during a visit, it is usually performed by an automated sphygmomanometer rather than by auscultation over the brachial artery, so an irregular pulse will go undetected. 7 But opportunistic pulse taking was less expensive than systematic 12‐lead electrocardiography, so opportunistic pulse taking followed by a 12‐lead ECG is now recommended as being cost‐effective. This study found that both opportunistic pulse taking and systematic screening detected similar numbers of unknown AF, and more than conventional care. #Cardiograph app shows irregular heartbeat trialGuidelines for screening for AF are based on a large‐cluster randomized controlled trial in general practice, of opportunistic pulse taking versus systematic screening with 12‐lead ECG or standard care. ![]() 2 This is the basis of guideline recommendations to screen for AF in those aged ≥65. 2 Because unknown asymptomatic AF is common, occurring in 1.4% of those aged 65 or older on a single time point check for presence of AF, 3 3% with patient‐activated recordings over 2 weeks, 4 and even more if long‐term continuous recordings are used, 5 it is intuitive that screening for AF and subsequent anticoagulant treatment should reduce the stroke burden related to AF. 1 Anticoagulation with warfarin or the non‐vitamin K–dependent oral anticoagulants is extremely effective in reducing stroke and mortality, but between a quarter and a third of all AF‐related strokes occur in patients with stroke as the first manifestation of AF. Indeed, recent stroke registries indicate that AF is associated with a third of all ischemic strokes.
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