Background: Timely detection of atrial fibrillation (AF) is important because of its increased risk of thrombo-embolic events. Single time point screening interventions fall short in detection of paroxysmal AF, which requires prolonged electrocardiographic monitoring, usually using a Holter. However, traditional 24-48 h Holter monitoring is less appropriate for screening purposes because of its low diagnostic yield. Intermittent, ambulatory screening using a single-lead electrocardiogram (1 L-ECG) device can offer a more efficient alternative.

Methods: Primary care patients of ≥65 years participated in an opportunistic screening study for AF. We invited patients with a negative 12 L-ECG to wear a Holter monitor for two weeks and to use a MyDiagnostick 1 L-ECG device thrice daily. We report the yield of paroxysmal AF found by Holter monitoring and calculate the diagnostic accuracy of the 1 L-ECG device's built-in AF detection algorithm with the Holter monitor as reference standard.

Results: We included 270 patients, of whom four had AF in a median of 8.0 days of Holter monitoring, a diagnostic yield of 1.5% (95%-CI: 0.4–3.8%). In 205 patients we performed simultaneous 1 L-ECG screening. For diagnosing AF based on the 1 L-ECG device's AF detection algorithm, sensitivity was 66.7% (95%-CI: 9.4–99.2%), specificity 68.8% (95%-CI: 61.9–75.1%), positive predictive value 3.1% (95%-CI: 1.4–6.8%) and negative predictive value 99.3% (95%-CI: 96.6–99.9%).

Conclusion: We found a low diagnostic yield of paroxysmal AF using Holter monitoring in elderly primary care patients with a negative 12 L-ECG. The diagnostic accuracy of an intermittently, ambulatory used MyDiagnostick 1 L-ECG device as interpreted by its built-in AF detection algorithm is limited.

背景：房颤（AF）的及时检测很重要，因为它增加了血栓栓塞事件的风险。单时间点筛查干预不足以检测阵发性房颤，这需要长时间的心电图监测，通常使用动态心电图。然而，由于诊断率低，传统的 24-48 小时动态心电图监测不太适合筛查目的。使用单导联心电图 (1 L-ECG) 设备进行间歇性动态筛查可以提供更有效的替代方案。

方法：≥65 岁的初级保健患者参加了一项针对 AF 的机会性筛查研究。我们邀请 12 L-ECG 阴性的患者佩戴 Holter 监护仪两周，并每天三次使用 MyDiagnostick 1 L-ECG 设备。我们报告了通过 Holter 监测发现的阵发性 AF 的发生率，并以 Holter 监测作为参考标准，计算了 1 L-ECG 设备内置 AF 检测算法的诊断准确性。

结果：我们纳入了 270 名患者，其中 4 名在中位 8.0 天的动态心电图监测中患有 AF，诊断率为 1.5%（95%-CI：0.4-3.8%）。在 205 名患者中，我们同时进行了 1 次 L-ECG 筛查。对于基于 1 L-ECG 设备的 AF 检测算法诊断 AF，敏感性为 66.7%（95%-CI：9.4-99.2%），特异性 68.8%（95%-CI：61.9-75.1%），阳性预测值 3.1 % (95%-CI: 1.4–6.8%) 和阴性预测值 99.3% (95%-CI: 96.6–99.9%)。

结论：我们发现在 12 L-ECG 阴性的老年初级保健患者中使用 Holter 监测对阵发性 AF 的诊断率较低。由其内置的 AF 检测算法解释的间歇性动态使用的 MyDiagnostick 1 L-ECG 设备的诊断准确性是有限的。