A new study suggests that peripheral pulse measurement (PPM) is a simple but accurate screening tool for identifying paroxysmal atrial fibrillation (pAF) following a stroke.
Researchers at Universitätsklinikum Erlangen (Germany) conducted a study involving 256 patients with acute ischemic stroke. Study participants, whom included the patients' themselves and their relatives, were instructed on how to identify the characteristics of pAF by measuring PPM at the radial artery, using standardized educational material. The measurements conducted by participants, as well as those by a health care professional, were then compared with simultaneous blinded electrocardiogram (ECG) to evaluate diagnostic accuracy parameters.
The results showed that PPM by the health care professional or patients' relatives had a diagnostic sensitivity of 96.5% and 76.5%, respectively, with 94% and 92.9% specificity for the detection of pAF. Self-measurements were reliably performed by 89.1% of competent patients, with a diagnostic sensitivity of 54.1% and 96.2% specificity. False-positive results were limited to 6 cases (2.7%) with a positive predictive value of 76.9% and a negative predictive value of 90%. The study was published on July 23, 2014, in Neurology.
“Screening pulse is the method of choice for checking for irregular heartbeat for people over age 65 who have never had a stroke. The majority of patients and their relatives can be trained to perform peripheral pulse measurement,” concluded lead author Bernd Kallmunzer, MD, and colleagues. “Our study shows it may be a safe, effective, noninvasive and easy way to identify people who might need more thorough monitoring to prevent a second stroke.”
“Every case of pathologic peripheral pulse measurement requires an ECG to confirm or refute the diagnosis of atrial fibrillation,” added the researchers. “Notably, false-positive results of peripheral pulse measurement were limited to a very low rate of 2.7%. Therefore, PPM as a first-step approach to atrial fibrillation detection offers a powerful tool to select patients in need of further cardiologic care and thorough ECG monitoring.”
Accurate diagnosis of AF is critical because antithrombotic treatment significantly reduces the risk of recurrent embolism and death. The dual objectives of the training sessions were to help participants learn to distinguish between rhythmic pulse sensation (normal) and absolute arrhythmic sensation (suspected AF), and to learn how to perform a measurement of the pulse rate using the stopwatch.
PPM is currently the most recommended evidence-based screening tool for identifying pAF in patients aged 65 and up, with no history of stroke. It is the only diagnostic tool recommended in the latest European Society of Cardiology (ESC) international guidelines for the management of AF.