Review Article

Diagnosing Paroxysmal Atrial Fibrillation: Are Biomarkers the Solution to This Elusive Arrhythmia?

Table 1

A summary of the main advantages and disadvantages of current diagnostic techniques for PAF (not bold) including potential biomarkers for PAF based on the evidence detailed in this review (bold) (unpublished).

Diagnostic classTechniqueSensitivitySpecificityAutomated analysisRemote analysisCostAdvantagesDisadvantages

ECG rhythm monitoringContinuous long-term ECG monitoring using implantable devicesHighHigh++HighHigh sensitivity and specificity Costly, invasive equipment required
Medium-term noninvasive ECG monitoring >24 hoursModerateHigh+/−+/−ModerateModerate sensitivity and specificity Patient inconvenience, some cases missed
Short-term ECG monitoring -24 hoursLowHigh+/−+/−Low to moderateRelatively inexpensiveLow diagnostic yield

Electrophysiological BiomarkersAnalysis of ECG indices, for example, P wave dispersion, QTc intervalLow to highModerate to highLowCost-effective test already in routine clinical practiceRelatively labour intensive without automated analysis. Room for potential error
Frequency of atrial premature beats on 24-hour  Holter monitorModerateLow-moderate+/−+/−Low to moderateNoninvasive test which the patient may already be undergoingLow specificity

Molecular biomarkersProteinsModerate to highModerate+LowMass screening possibleRelatively low specificity
microRNAsExpected to be equivalent to protein biomarkers

Morphological biomarkersEchocardiography LA size LowModerateModerateNoninvasive test which the patient may already be undergoing. LA size is a standard measurementHighly trained specialists and costly equipment required
Echocardiography LA function, for example,  myocardial tissue DopplerHighModerateModerateNoninvasive test which the patient may already be undergoingHighly trained specialists and costly equipment required. Potential room for error in patients with suboptimal  image quality