Screening for Atrial Fibrillation With Smartphone ECG

Study Questions:

Can a smartphone-based wireless single-lead electrocardiogram (ECG) be used to screen for atrial fibrillation (AF)?


Hong Kong residents who participated in a territory-wide community-based AF screening program between May 2014 and April 2015 were included in this analysis. Single-lead ECGs were obtained through a smartphone device by trained nonmedical volunteers. ECGs were classified by sinus rhythm, AF, and uninterpretable. Additional information was obtained through surveys that the participants completed.


A total of 13,122 Hong Kong adults were included in this study. Of the 13,122 single-lead ECGs obtained, 56 (0.4%) were not able to be interpreted. A total of 101 (0.8%) of the population were newly diagnosed with AF. Most of these participants 66/101 (65.3%) were asymptomatic. Newly diagnosed AF was associated with the presence of congestive heart failure, hypertension, age >75 years, diabetes, stroke, vascular disease, age 65–74 years, and sex. Mean CHA2DS2-VASc score of the participants with newly diagnosed AF was 3.1. Comparing those with newly diagnosed AF to no AF, independent predictors of AF included age, body mass index, stroke, valvular heart disease, hyperlipidemia, coronary artery disease, and peripheral artery disease. Female sex was associated with a lower risk for newly diagnosed AF.


The investigators concluded that community screening for AF with a single-lead ECG was feasible and it identified a significant proportion of participants with newly diagnosed AF. The prevalence of AF in a Chinese population in Hong Kong was comparable with that of contemporary Western counterparts. Apart from age and sex, different anthropometric parameters and cardiovascular comorbid conditions were identified as independent predictors of AF.


This study highlights the potential for smartphone-derived data to be used in screening protocols. Further study to determine if such widespread screening would result in reduced incidence of stroke is warranted.

Clinical Topics: Arrhythmias and Clinical EP, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Valvular Heart Disease, Atherosclerotic Disease (CAD/PAD), Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Hypertension

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Body Mass Index, Cellular Phone, Coronary Artery Disease, Diabetes Mellitus, Electrocardiography, Heart Failure, Heart Valve Diseases, Hyperlipidemias, Hypertension, Peripheral Arterial Disease, Primary Prevention, Stroke, Vascular Diseases

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