A 79-Year-Old Woman With a Pacemaker and High Atrial Rates

Jeff S. Healey, MD, MSc, FRCPC; Jonathan P. Piccini, MD, MHS, FACC; Christian T. Ruff, MD, MPH


March 22, 2019

Editorial Collaboration

Medscape &

The results of the ARTESiA and NOAH-AF trials will have major implications for the viability and logistics of population-based atrial fibrillation screening.[7,8,15] Short-lasting subclinical atrial fibrillation is much more common than clinical atrial fibrillation that is detected with single time-point, ECG-based screening. However, detecting such episodes is cumbersome and more costly. If treating subclinical atrial fibrillation proves worthwhile, then screening for longer periods of time may prove to be a cost-effective way to prevent stroke in the population.[15] Otherwise, simple intermittent screening or symptom-driven investigations may be preferred.

Insights from pacemaker studies and studies in a more general population have shown that subclinical atrial fibrillation is common and associated with stroke.[17] Ongoing studies will determine when and how patients with subclinical atrial fibrillation should be treated and will help clarify whether population-based screening for atrial fibrillation is a cost-effective stroke-prevention strategy.


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