Comparison of continuous 24-h and 14-day monitoring for detection of otherwise unknown atrial fibrillation: a registry to identify Japanese concealed atrial fibrillation (REAL-AF)-based study

  • Koichi NagashimaEmail author
  • Yasuo Okumura
  • Katsuaki Yokoyama
  • Naoya Matsumoto
  • Eizo Tachibana
  • Keiichiro Kuronuma
  • Koji Oiwa
  • Michiaki Matsumoto
  • Toshiaki Kojima
  • Hideyuki Ando
  • Kazumiki Nomoto
  • Ken Arima
  • Atsushi Hirayama
  • the REAL AF StudyInvestigators
Original Article


Early detection of atrial fibrillation (AF) is desirable for preventing strokes. Not only does AF often go undetected in patients being followed up for various disease conditions, but the optimal detection method also remains to be elucidated. In a prospective observational study of 24-h Holter monitoring versus 14-day external loop recording performed for detection of previously undiagnosed AF in 868 Japanese outpatients (aged 75 ± 6 years), with a CHA2DS2-vasc score ≥ 1, but no prior AF episodes, AF was detected during the initial monitoring period in 16 (1.8%) patients, in 7 (1.1% [7/645]) by 24-h monitoring and 9 (4.0% [9/223]) by 14-day monitoring (P = 0.005), and overall in 32 (3.7%) during the 1-year study period. Absence of a beta-blocker therapy and the serum N-terminal pro-brain natriuretic peptide level were independent predictors of a new detection of AF. Oral anticoagulation (OAC) therapy was given to 22 (69%) of the 32 patients in whom AF was detected, and no difference in the incidence of subsequent major adverse events was found between the patients managed with and without oral OAC therapy. Previously unknown AF was documented at a prevalence of 3.7% per year among Japanese with a notable CHA2DS2-VASc score, and 14-day external loop monitoring was significantly more effective for detection of the disorder. A large-scale prospective AF screening study conducted to clarify the type or types of patients who would benefit from “early” OAC therapy for primary stroke prevention is warranted.


Atrial fibrillation Continuous monitoring Oral anticoagulant therapy 



We thank Mr. John Martin for his help in the preparation of the manuscript.


The study was supported by Bristol-Myers Squibb and Pfizer. Okumura Yasuo received the funding described above for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Koichi Nagashima
    • 1
    Email author
  • Yasuo Okumura
    • 1
  • Katsuaki Yokoyama
    • 2
  • Naoya Matsumoto
    • 2
  • Eizo Tachibana
    • 3
  • Keiichiro Kuronuma
    • 3
  • Koji Oiwa
    • 4
  • Michiaki Matsumoto
    • 4
  • Toshiaki Kojima
    • 5
  • Hideyuki Ando
    • 6
  • Kazumiki Nomoto
    • 7
  • Ken Arima
    • 8
  • Atsushi Hirayama
    • 1
  • the REAL AF StudyInvestigators
  1. 1.Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
  2. 2.Department of CardiologyNihon University HospitalTokyoJapan
  3. 3.Kawaguchi Municipal Medical CenterSaitamaJapan
  4. 4.Yokohama Chuo HospitalYokohamaJapan
  5. 5.Sekishindo HospitalSaitamaJapan
  6. 6.Keiai HospitalTokyoJapan
  7. 7.Tokyo Rinkai HospitalTokyoJapan
  8. 8.Kasukabe Medical CenterSaitamaJapan

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