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European Journal of Preventive... Aug 2016Pulse palpation has been recommended as the first step of screening to detect atrial fibrillation. We aimed to determine and compare the accuracy of different methods... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pulse palpation has been recommended as the first step of screening to detect atrial fibrillation. We aimed to determine and compare the accuracy of different methods for detecting pulse irregularities caused by atrial fibrillation.
METHODS
We systematically searched MEDLINE, EMBASE, CINAHL and LILACS until 16 March 2015. Two reviewers identified eligible studies, extracted data and appraised quality using the QUADAS-2 instrument. Meta-analysis, using the bivariate hierarchical random effects method, determined average operating points for sensitivities, specificities, positive and negative likelihood ratios (PLR, NLR); we constructed summary receiver operating characteristic plots.
RESULTS
Twenty-one studies investigated 39 interventions (n = 15,129 pulse assessments) for detecting atrial fibrillation. Compared to 12-lead electrocardiography (ECG) diagnosed atrial fibrillation, blood pressure monitors (BPMs; seven interventions) and non-12-lead ECGs (20 interventions) had the greatest accuracy for detecting pulse irregularities attributable to atrial fibrillation (BPM: sensitivity 0.98 (95% confidence interval (CI) 0.92-1.00), specificity 0.92 (95% CI 0.88-0.95), PLR 12.1 (95% CI 8.2-17.8) and NLR 0.02 (95% CI 0.00-0.09); non-12-lead ECG: sensitivity 0.91 (95% CI 0.86-0.94), specificity 0.95 (95% CI 0.92-0.97), PLR 20.1 (95% CI 12-33.7), NLR 0.09 (95% CI 0.06-0.14)). There were similar findings for smartphone applications (six interventions) although these studies were small in size. The sensitivity and specificity of pulse palpation (six interventions) were 0.92 (95% CI 0.85-0.96) and 0.82 (95% CI 0.76-0.88), respectively (PLR 5.2 (95% CI 3.8-7.2), NLR 0.1 (95% CI 0.05-0.18)).
CONCLUSIONS
BPMs and non-12-lead ECG were most accurate for detecting pulse irregularities caused by atrial fibrillation; other technologies may therefore be pragmatic alternatives to pulse palpation for the first step of atrial fibrillation screening.
Topics: Atrial Fibrillation; Electrocardiography; Heart Rate; Humans; Palpation; ROC Curve
PubMed: 26464292
DOI: 10.1177/2047487315611347 -
Nursing Nov 1993Pulse deficit--the difference between the apical and peripheral pulse rates--can signal an arrhythmia. You'll need to monitor this deficit if your patient's pulse rhythm...
Pulse deficit--the difference between the apical and peripheral pulse rates--can signal an arrhythmia. You'll need to monitor this deficit if your patient's pulse rhythm is irregular.
Topics: Arrhythmias, Cardiac; Heart Rate; Humans; Nursing Assessment; Pulse
PubMed: 8233155
DOI: 10.1097/00152193-199311000-00009 -
Best Practice & Research. Clinical... Jul 2019Fetal dysrhythmias are common abnormalities, usually manifesting as irregular rhythms. Although most irregularities are benign and caused by isolated atrial ectopics, in... (Review)
Review
Fetal dysrhythmias are common abnormalities, usually manifesting as irregular rhythms. Although most irregularities are benign and caused by isolated atrial ectopics, in a few cases, rhythm irregularity may indicate partial atrioventricular block, which has different etiological and prognostic implications. We provide a flowchart for the initial management of irregular rhythm to help select cases requiring urgent specialist referral. Tachycardias and bradycardias are less frequent, can lead to hemodynamic compromise, and may require in utero therapy. Pharmacological treatment of tachycardia depends on the type (supraventricular tachycardia or atrial flutter) and presence of hydrops, with digoxin, flecainide, and sotalol being commonly used. An ongoing randomized trial may best inform about their efficacy. Bradycardia due to blocked bigeminy normally resolves spontaneously, but if it is due to established complete heart block, there is no effective treatment. Ongoing research suggests hydroxychloroquine may reduce the risk of autoimmune atrioventricular block. Sinus bradycardia (rate <3rd centile) may be a prenatal marker for long-QT syndrome.
Topics: Arrhythmias, Cardiac; Echocardiography; Female; Fetal Diseases; Fetal Therapies; Heart Block; Heart Rate, Fetal; Humans; Pregnancy; Risk Assessment; Ultrasonography, Doppler; Ultrasonography, Prenatal
PubMed: 30738635
DOI: 10.1016/j.bpobgyn.2019.01.002 -
Critical Reviews in Biomedical... 2019Heart rate and through-body blood perfusion are vital measurements in all stages of patient care, be it predictive, in the clinical setting, or outpatient monitoring....
Heart rate and through-body blood perfusion are vital measurements in all stages of patient care, be it predictive, in the clinical setting, or outpatient monitoring. Irregular, underachieving, or overperforming heart rate is the main precursor of most cardiovascular diseases that have severe long-term complications. In addition to heart rate, the shape of the pulse waveforms can indicate the heart's valve health and electrophysiology health. The goal of the study was to design a noninvasive device for continuously measuring a patient's heart rate with clinical-grade accuracy along with the ability to indicate pulse waveforms for the patient and physician. An accurate, easy-to-use heart-rate measuring device prototype was developed that did not require the sensor to have direct skin contact to obtain measurements. The statistical analysis of the data gathered by the prototype compared to the data collected from the industry standard device indicated significant correlation. The two-sample T-test for the data recorded from the prototype and the data collected from the industry commercially available pulse oximeter showed a P-value of 0.521, which indicates that there was no significant difference between the prototype and the commercially available pulse oximeter when measuring heart rate.
Topics: Alkenes; Calibration; Electrocardiography; Electrophysiological Phenomena; Equipment Design; Ethylenes; Heart Rate; Humans; Linear Models; Materials Testing; Microcomputers; Movement; Oximetry; Oxygen; Perfusion; Reproducibility of Results; Styrene
PubMed: 31679242
DOI: 10.1615/CritRevBiomedEng.2019026539 -
Physiological Reports Nov 2018The relationship between autonomic function and recovery following prolonged arduous exercise in women has not been examined. We undertook an exploratory study that...
The relationship between autonomic function and recovery following prolonged arduous exercise in women has not been examined. We undertook an exploratory study that aimed to examine the temporal change in linear and nonlinear measures of heart rate variability (HRV) following prolonged arduous exercise in the form of first all-female (mean age 32.7 ± 3.1 years) team to attempt an unassisted Antarctic traverse. HRV analysis was performed before and 1, 4, and 15 days postexpedition. The traverse was completed in 61 days. There was a significant paired reduction in heart rate, LnLF, LF:HF, DFAα1 between baseline and 15 days postexercise in the same environment. Conversely, RMSSD, LnHF and HFnu, SD1:SD2, and SampEn significantly increased. DFAα2 levels significantly fell from baseline to Day 1 postexercise. In conclusion, we observed a significant latent increase in relative parasympathetic dominance and RR interval irregularity at 15 days post prolonged arduous exercise, versus pre-exercise baseline, in a group of very fit and healthy adult women.
Topics: Adult; Endurance Training; Female; Heart; Heart Rate; Humans; Parasympathetic Nervous System; Physical Exertion; Recovery of Function
PubMed: 30381902
DOI: 10.14814/phy2.13905 -
Clinical Cardiology May 2021The 2020 European Society of Cardiology atrial fibrillation guidelines recommend opportunistic screening for atrial fibrillation by pulse taking or ECG rhythm strip in...
BACKGROUND
The 2020 European Society of Cardiology atrial fibrillation guidelines recommend opportunistic screening for atrial fibrillation by pulse taking or ECG rhythm strip in those aged over 65 years.
HYPOTHESIS
We aimed to compare the diagnostic accuracy of pulse palpation to ECG rhythm strip when screening for atrial fibrillation. A secondary aim was to investigate whether participants with palpitations were more likely to be diagnosed with new atrial fibrillation.
METHODS
The study population were 75/76 year old individuals that participated in the STROKESTOP II study, a Swedish screening study for atrial fibrillation. Pulse palpation of the radial pulse for 30 sec was performed by healthcare professionals and recorded as regular or irregular. Thereafter a 30-sec single-lead ECG was registered. Patients were asked also if they had a history of palpitations.
RESULTS
Of the 6159 participants included in the study, 461 (7.5%) had irregular pulse. Twenty-two (4.8%) of those with irregular pulse were diagnosed with atrial fibrillation on single-lead ECG rhythm strip. Among those with regular pulse, 6 (0.1%) cases of new atrial fibrillation were found. The sensitivity of the pulse palpation test was 78.6% and positive predictive value 4.8%. The proportion of newly diagnosed atrial fibrillation was not different between those with and without history of palpitations.
CONCLUSION
Pulse palpation was inferior to single-lead ECG when screening for atrial fibrillation. We therefore advocate the use of single-lead ECG rather than pulse palpation when screening for atrial fibrillation. Palpitations did not predict atrial fibrillation.
Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Cohort Studies; Electrocardiography; Female; Heart Rate; Humans; Male; Mass Screening; Palpation
PubMed: 33724492
DOI: 10.1002/clc.23595 -
The Journal of Family Practice Feb 2006Atrial fibrillation in the elderly is common and potentially life threatening. The classical sign of atrial fibrillation is an irregularly irregular pulse. (Review)
Review
BACKGROUND
Atrial fibrillation in the elderly is common and potentially life threatening. The classical sign of atrial fibrillation is an irregularly irregular pulse.
OBJECTIVE
The objective of this research was to determine the accuracy of pulse palpation to detect atrial fibrillation.
METHODS
We searched Medline, EMBASE, and the reference lists of review articles for studies that compared pulse palpation with the electrocardiogram (ECG) diagnosis of atrial fibrillation. Two reviewers independently assessed the search results to determine the eligibility of studies, extracted data, and assessed the quality of the studies.
RESULTS
We identified 3 studies (2385 patients) that compared pulse palpation with ECG. The estimated sensitivity of pulse palpation ranged from 91% to 100%, while specificity ranged from 70% to 77%. Pooled sensitivity was 94% (95% confidence interval [CI], 84%-97%) and pooled specificity was 72% (95% CI, 69%-75%). The pooled positive likelihood ratio was 3.39, while the pooled negative likelihood ratio was 0.10.
CONCLUSIONS
Pulse palpation has a high sensitivity but relatively low specificity for atrial fibrillation. It is therefore useful for ruling out atrial fibrillation. It may also be a useful screen to apply opportunistically for previously undetected atrial fibrillation. Assuming a prevalence of 3% for undetected atrial fibrillation in patients older than 65 years, and given the test's sensitivity and specificity, opportunistic pulse palpation in this age group would detect an irregular pulse in 30% of screened patients, requiring further testing with ECG. Among screened patients, 0.2% would have atrial fibrillation undetected with pulse palpation.
Topics: Atrial Fibrillation; Diagnosis, Differential; Humans; Palpation; Pulse; Reproducibility of Results; Risk Factors
PubMed: 16451780
DOI: No ID Found -
Hypertension Research : Official... Aug 2022
Topics: Algorithms; Atrial Fibrillation; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Heart Rate; Humans; Monitoring, Ambulatory
PubMed: 35618813
DOI: 10.1038/s41440-022-00943-y -
Hypertension Research : Official... Sep 2022
Topics: Atrial Fibrillation; Blood Pressure; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory; Humans; Pulse
PubMed: 35768726
DOI: 10.1038/s41440-022-00971-8 -
Circulation. Arrhythmia and... Oct 2021[Figure: see text].
[Figure: see text].
Topics: Aged; Algorithms; Atrial Fibrillation; Electrocardiography; Female; Heart Rate; Humans; Male; Middle Aged; Mobile Applications; Tachycardia, Ventricular; Telemedicine; Wearable Electronic Devices
PubMed: 34565178
DOI: 10.1161/CIRCEP.121.010063