Is pulse palpation helpful in detecting atrial fibrillation? A systematic review

Cooke, Georga, Doust, Jenny and Sanders, Sharon (2006) Is pulse palpation helpful in detecting atrial fibrillation? A systematic review. Journal of Family Practice, 55 2: 130-134.

Author Cooke, Georga
Doust, Jenny
Sanders, Sharon
Title Is pulse palpation helpful in detecting atrial fibrillation? A systematic review
Journal name Journal of Family Practice   Check publisher's open access policy
ISSN 0094-3509
Publication date 2006-02
Sub-type Article (original research)
Volume 55
Issue 2
Start page 130
End page 134
Total pages 5
Editor C. Williams
Place of publication Parsippany, NJ, United States
Publisher Quadrant HealthCom
Collection year 2006
Language eng
Subject CX
321003 Cardiology (incl. Cardiovascular Diseases)
730106 Cardiovascular system and diseases
Abstract 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.
Keyword Medicine, General & Internal
Q-Index Code C1
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
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Created: Wed, 15 Aug 2007, 08:52:05 EST