In the early days of the pandemic, we were debating the merits of telemedicine to avoid bringing patients into the office. I was very much in favor of telemedicine, but some of my colleagues argued that seeing patients in person in the clinic gave you the opportunity to do ECGs and catch atrial fibrillation (AF).
I don't doubt that you will catch some AF that way and that some patients might have AF and not realize it if they don't regularly come into contact with the medical system. But screening for AF has always been a tricky proposition and the evidence for it has been scant.
Two recent trials from the European Society of Cardiology (ESC) have actually made the question less clear, at least in my mind. The findings from LOOP and STROKESTOP were, superficially at least, contradictory. LOOP showed no benefit to screening asymptomatic, at-risk patients for AF whereas STROKESTOP did.
However, the different approaches used to screen for AF likely explain some of these differences. The LOOP study used an implantable loop recorder and anticoagulated anyone with episodes of AF lasting 6 minutes or more, whereas STROKESTOP had patients in the intervention arm get twice-daily ECGs for 2 weeks.
