Baylor University Medical Center Proceedings July 2017 - 284

Mobile single-lead handheld or wearable ECG devices provide a
high diagnostic yield because they can be worn for an extended
period and allow for repeat screening (59-63).
A potential limitation of our review is that only one study
explored the prevalence of paroxysmal AF (PAF) across rural
populations (26). It is accepted that the standard 12-lead ECG
has a low sensitivity for PAF detection. PAF is largely asymptomatic, although it carries an identical risk for stroke as persistent AF (64, 65). We have thus identiﬁed the burden of PAF
in rural areas globally as unknown.
In summary, our review explored published studies from
1965 to 2016 (more than ﬁve decades) on rural AF. We found
that the overall prevalence of global rural community AF was
2.05% and ranged from 0.3% to 10.87%. Information on the
burden of rural AF is necessary for better provision of care
and distribution of resources in rural populations (66). The
12-lead ECG was the primary screening tool for AF. However,
the emergence of novel mobile ECG technologies for rhythm
monitoring and interpretation may facilitate better AF detection in resource-limited areas. Reported AF risk factors varied
across studies, and none of the studies assessed all potential risk
factors. We also acknowledge there may be paradoxes in rural
populations. For example, we noted reduced associations for
AF and male gender in Tanzania (25) and China (29), and for
age and AF burden in Tanzania (25). We suggest that future
screening for AF in rural communities may better understand
the true burden of rural AF across rural regions of diﬀerent
countries. Indeed, an examination of a complete checklist of
AF risk factors may facilitate a better understanding of their
association with AF burden.
1.

4.
5.

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Baylor University Medical Center Proceedings

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