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EDITORIALS: Henk C P M van Weert Diagnosing atrial fibrillation in general practice BMJ 2007; 335: 355-356 [Full text]

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opportunistic screening for atrial fibrillation

oscar,m jolobe   (24 August 2007)

Quality of ECG recordings

E Wright   (27 August 2007)

Article should not be subject to mis-interpretation

Bedansh Chaudhary   (28 August 2007)

opportunistic screening for atrial fibrillation 24 August 2007
oscar,m jolobe, retired geriatrician manchester medical society, c/o john rylands university library, mancheste, M13 9PP Send response to journal: Re: opportunistic screening for atrial fibrillation	Opportunistic screening for atrial fibrillation(AF) ought to include, not just the elderly(1), but also high risk groups such as patients with hypertension(2) and, to a lesser extent, those with ischaemic heart disease(2). There should also be a heightened index of suspicion for risk of AF when the electrocardiogram(which should be part of the routine "work up" of all patients with hypertension) shows either left atrial hypertrophy(ie p mitrale) or atrial ectopic beats, the latter being now acknowledged to be predictors of new-onset atrial fibrillation(3). Arguably, in the light of the latter study, the association of atrial ectopic beats and ST segment abnormality(ranging from T wave flattening to ST segment depression) ought to be an indication for further investigation including Holter monitoring so as to facilitate early diagnosis of paroxysmal AF. References (1)van Weert HCPM Diagnosing atrial fibrillation in general practice British Medical Journal 2007:335:355-6 (2)Go AS., Hylek EM., Phillips KA et al Prevalence of diagnosed atrial fibrillation in adults Journal of the American Medical Association 2001:285:2370-5 (3) Watanabe H., Tanabe N., Makiyama Y et al ST-segment abnormalities and premature complexes are predictors of new- onset atrial fibrillation: The Niigata Preventive Medicine Study American Heart Journal 2006:152:731-5 Competing interests: None declared
Quality of ECG recordings 27 August 2007
E Wright, Cardiac Physiologist Western General Hospital, Edinburgh, EH4 2XU Send response to journal: Re: Quality of ECG recordings	Dear Doctors, As a physiologist of many years experience, I have read the articles on screening for atrial fibrillation with interest. I am concerned that the quality of the recordings were not really questioned. I have become increasingly aware of the poor quality recordings carried out by nursing and medical staff who cannot accurately place chest leads and do not know how to eliminate the problems of artefact. This is probably due to lack of training and/or experience and time factors. I appreciate that many technical staff are also guilty of poor recordings, however every GP referral to our department for ECG is reported by the software and then checked by senior cardiac physiologists prior to sending the patient away. We would correct an inaccurate software report. However, if the physiologist sees any reason that it may not be safe to do so we would contact a Cardiologist, in other cases we would send the patient back to the GP with the recording. May I suggest the following guidelines issued by the Society of Cardiological Science and Technology and the British Cardiovascular Society be read: Clinical Guidelines by Consensus: Recording a standard 12 lead electrocardiogram, An Approved Methodology. This can be downloaded from the Society of Cardiological Science and Technology website www.scst.org.uk. Copy the following in to a browser window http://www.scst.org.uk/docs/Consensus%20guidelines%20for%20recording%20a%2012%20lead%20ECG%201106.pdf Thank you for allowing me to comment. Competing interests: None declared
Article should not be subject to mis-interpretation 28 August 2007
Bedansh Chaudhary, Neurosurgical trainee Manchester Send response to journal: Re: Article should not be subject to mis-interpretation	Dear Sir Mant et al are keen to highlight the point in their discussion that general practioners were unable to diagnose atrial fibrillation (AF) accurately on an electrocardiogram (ECG). However I feel there are a number of points which are not considered in this article. As doctors, we are taught to rely heavily on clear history taking and through examination when making a diagnosis. The implications suggested by mant et al in this article mention more than half of diagnoses of AF in primary care are incorrect. I would like to question where this figure was obtained from. The statement indicates drawing such conclusions from this article which only looked at practioners diagnosing AF from an ECG. Certainly any practioner would not only make a clinical diagnosis from only reading a trace. Infact this would be last after a history and certainly palpating a pulse as part of a relevant examination. It is not also made clear regarding the population of General Practioners (GP) that were chosen and whether any of them had further postgraduate experience or specialist interests in medical specialities. The quality of ECG tracings has not been questioned either. Maybe the author should have put a sample of the ECG tracings in the article that were sent to the practioners. Thank you Competing interests: None declared