BACKGROUND Stroke is an increasing health problem worldwide. Atrial fibrillation (AF) is a major risk factor for stroke, and the attention given to AF screening is rising, as new monitoring technologies emerge. We aimed to evaluate the performance of a large panel of screening strategies and to assess population characteristics associated with diagnostic yield. METHODS Individuals with stroke risk factors but without AF were recruited from the general population to undergo screening with an implantable loop recorder. New-onset AF lasting ≥6 minutes was adjudicated by senior cardiologists. After continuous monitoring for >3 years, complete day-to-day heart rhythm data sets were reconstructed for every participant, including exact time of onset and termination of all AF episodes. Random sampling was applied to assess the sensitivity and negative predictive value of screening with various simulated screening strategies compared with the implantable loop recorder. The diagnostic yield across strategies and population subgroups was compared by use of nonparametric tests. RESULTS The rhythm data sets comprised 590 participants enduring a total of 659 758 days of continuous monitoring and 20 110 AF episodes. In these data, a single 10-second ECG yielded a sensitivity (and negative predictive value) of 1.5% (66%) for AF detection, increasing to 8.3% (67%) for twice-daily 30-second ECGs during 14 days and to 11% (68%), 13% (68%), 15% (69%), 21% (70%), and 34% (74%) for a single 24-hour, 48-hour, 72-hour, 7-day, or 30-day continuous monitoring, respectively. AF detection further improved when subsequent screenings were performed or when the same monitoring duration was spread over several periods compared with a single period (eg, three 24-hour monitorings versus one 72-hour monitoring; P<0.0001 for all comparisons). The sensitivity was consistently higher among participants with age ≥75 years, male sex, CHADS2 score >2, or NT-proBNP (N-terminal pro-B-type natriuretic peptide) ≥40 pmol/L and among participants with underlying ≥24-hour AF episodes compared with shorter AF (P<0.0001 for all screening strategies). CONCLUSIONS In screening for AF among participants with stroke risk factors, the diagnostic yield increased with duration, dispersion, and number of screenings, although all strategies had low yield compared with the implantable loop recorder. The sensitivity was higher among participants who were older, were male, or had higher NT-proBNP. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02036450.

中文翻译：

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房颤筛查的心律监测策略的综合评估：高危患者的见解，可通过植入式记录仪长期监测。

背景技术中风是世界范围内日益严重的健康问题。心房颤动（AF）是中风的主要危险因素，随着新的监测技术的出现，对房颤筛查的关注日益增加。我们旨在评估大量筛选策略的性能，并评估与诊断率相关的人群特征。方法从一般人群中招募有卒中危险因素但无房颤的个体，以植入式循环记录仪进行筛查。高级心脏病专家判定持续时间≥6分钟的新发房颤。在连续监测> 3年后，为每个参与者重建了完整的每日心律数据集，包括所有AF发作的确切发作时间和终止时间。与植入式环路记录仪相比，采用随机抽样来评估采用各种模拟筛选策略进行筛选的敏感性和阴性预测价值。使用非参数检验比较了策略和人群亚组的诊断率。结果心律数据集包括590名参与者，共进行了659 758天的连续监测和20 110次AF发作。在这些数据中，单个10秒ECG对AF检测产生的敏感度（和负预测值）为1.5％（66％），在14天之内每天两次30秒ECG的敏感度提高至8.3％（67％）。分别在24小时，48小时和72小时内达到11％（68％），13％（68％），15％（69％），21％（70％）和34％（74％） ，7天或30天连续监控。当进行后续筛查或与单个时期相比，相同的监测持续时间分散于多个时期时（例如，三个24小时监测与一个72小时监测；对于所有比较，P <0.0001），AF检测进一步改善。在年龄≥75岁，男性，CHADS2评分> 2或NT-proBNP（N端前B型利尿钠肽）≥40 pmol / L的受试者和基础≥24-mol的受试者中，敏感性始终较高。与较短的AF相比，每小时的AF发作次数更多（所有筛查策略的P <0.0001）。结论在有卒中危险因素的参与者中进行房颤筛查时，诊断率随筛查时间，弥散度和筛查次数的增加而增加，尽管与可植入式环路记录仪相比，所有策略的收率均较低。在年龄较大，男性或NT-proBNP较高的受试者中，敏感性较高。注册：URL：https：//www.clinicaltrials.gov；唯一标识符：NCT02036450。