Opportunities and challenges of large-scale screening for atrial fibrillation

Atrial fibrillation (AF) is a common arrhythmia and is highly associated with stroke and cardiovascular morbidity. As many AF episodes remain subclinical (SCAF), large-scale AF screening is considered a desirable approach for the treatment and prevention of cardioembolic stroke. Newly available single-lead ECG devices have provided promising results in the diagnosis of SCAF and treatment by nonvitamin K antagonist drugs appears to be safe and effective. Nevertheless, a further gain in knowledge is needed to clarify the different types of AF. This may help to define how or if a patient should be treated in the context of outcome and cost effectiveness. This review summarizes the results of recent research in this field and focuses on single-lead, discontinuous single time-point, community-based comprehensive-screening-based AF management. We want to conclude that progress in ECG diagnosis and anticoagulation therapy has prepared the ground to establish large-scale AF screening. The remaining question, however, is which patients should be screened and what therapy should be initiated in case of AF.