Diagnostic Accuracy of Apex-Pulse Deficit for Detecting Atrial Fibrillation

Abstract

Objective: To evaluate the diagnostic accuracy of Apex-Pulse deficit for detecting Atrial Fibrillation in adult patients Study Design: Cross sectional study Place and Duration of Study: Department of Medicine, Combined Military Hospital, Peshawar Pakistan, Nov 2022 to Oct 2023 Methodology: One hundred and thirty-nine patients, aged 18 years or more, newly diagnosed with atrial fibrillation (A-fib) or a history of palpitations were evaluated independently by three separate groups of two examiners each for the presence of Apex-Pulse deficit. A-fib was later confirmed with ECG and Holter monitoring. Sensitivity and specificity were calculated for both diagnostic methods. Pearson correlation was calculated for correlation of the severity of Apex-Pulse deficit with the New York Heart Association (NYHA) Class of heart failure. Results: The mean age of patients was 44.32±13.22 years with 66.2%(n=92) females and 33.8%(n=47) males. Patients had symptoms of the atrial fibrillation for a mean duration of 2.99±2.03 days. Apex-Pulse deficit was noticed in 75.5%(n=105) of the studied cohort. There was a linear relation between the NYHA Class and Apex-Pulse deficit severity with Pearson Correlation coefficient of 0.764 (p<0.001). The Apex-Pulse deficit method was able to detect atrial fibrillation in 78.4%(n=109) of the patients with a sensitivity of 96.33% and a specificity of 0% whereas ECG was able to detect the atrial fibrillation with a sensitivity and specificity of 100%. Conclusion: The assessment of the Apex-Pulse deficit as a diagnostic tool for detecting Atrial Fibrillation has high sensitivity of 96%.

Keywords

• Apex-Pulse deficit, Ambulatory Electrocardiography, Atrial Fibrillation, Holter.