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Accuracy of diagnosing atrial fibrillation on electrocardiogram by primary care practitioners and interpretative diagnostic software: analysis of data from screening for atrial fibrillation in the elderly (SAFE) trial

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39227.551713.AE (Published 23 August 2007) Cite this as: BMJ 2007;335:380

Rapid Response:

Recognizing of atrial fibrillation (AF) on ECG in man: almost 100 years, but obviously not enough

With all compliments for the study, results are expected in terms
that there is no wonder in lower capability of GPs to recognize AF (in
comparison to cardiologists). Likewise, cardiologists will always be below
the diagnostic accuracy of dermatologists in the case of e.g. pemphigus.
On the other hand, results are discouraging for doctors as professionals
in general, because almost everyone expected better diagnostic skill.
Moreover, results are probably particularly disappointing from the
patients’ point of view, knowing how symptomatic and risky AF can be,
especially if comorbidities coexist.

AF has been very important, being the most common chronic arrhythmia,
as well as the most common cardiac disorder in the United States (1), with
huge 90 times gradient in prevalence (from from 0.1% in people <_55 years="years" of="of" age="age" to="to" _9="_9" in="in" people="people" over="over" _80="_80" _1.="_1." p="p"/> The personal experience suggest that by far the most common source of
failure to recognize AF has been focusing on detection of “p” waves (and
confusing them with flutter “F” or fibrillation “f” waves), without paying
attention to rhythm irregularity.

Since the first ECG in AF in man in 1909 by Rothberger and Winterberg
(2), it is a pity that the probability that a positive diagnosis was
correct was only 41% in the study of Mant et al. (3).

1.Abusaada K, Sharma SB, Jaladi R, Ezekowitz MD. Epidemiology and
management of new-onset atrial fibrillation. Am J Manag Care. 2004;10(3
Suppl):S50-7.

2.Lip GYH , Atrial fibrillation in clinical practice, Martin Dunitz,
2001.

3.Mant J, Fitzmaurice D, Hobbs R, Jowett S, Murray E, Holder R,
Davies M, Lip GYH. Accuracy of diagnosing atrial fibrillation on
electrocardiogram by primary care practitioners and interpretative
diagnostic software: analysis of data from screening for atrial
fibrillation in the elderly (SAFE) trial. BMJ 2007: 39227.551713.AE.

Competing interests:
None declared

Competing interests: No competing interests

20 July 2007
Goran Koracevic
Assist. Prof.
Department for Cardiovascular Diseases, Medical Faculty, Clinical Centre, 18000 Nis, Serbia,