A comparison between the 12-lead electrocardiogram and hand-held spectral waveform doppler ultrasound in the detection of atrial fibrillation (Master's dissertation).

Abstract

Background: Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia and a leading cause of thromboembolic stroke. Early detection is essential to initiate timely intervention and reduce associated morbidity and mortality. While electrocardiography (ECG) remains the gold standard for AF diagnosis, its routine use in community settings is limited. Pedal Doppler ultrasound (US) is already widely utilised in podiatric practice for vascular assessments, offering a potential opportunity for opportunistic AF screening during routine foot care. However, evidence quantifying the accuracy of pedal Doppler US for arrhythmia detection is limited. Aim: This study aimed to evaluate the accuracy of pedal Doppler US in identifying atrial fibrillation when compared with ECG findings, to determine its potential role as an opportunistic screening tool within podiatric practice. Methods: A cross-sectional study was conducted involving 112 participants aged 65 years and older. Pedal Doppler US was used to classify peripheral pulse patterns as regular, partially regular, or irregular. ECG served as the reference standard to confirm the presence or absence of arrhythmias. Chi-square analysis was employed to assess the association between Doppler findings and ECG results, and Cramér’s V was calculated to estimate effect size. Results: A strong, statistically significant association was found between Doppler-detected irregular pulses and ECG-confirmed arrhythmias (χ²(1, N=112)=52.42, p<0.001, Cramér’s V=0.68). Doppler US reliably identified all cases of irregularly irregular rhythms indicative of AF but failed to detect regular arrhythmias such as first-degree atrioventricular block and sinus bradycardia. Conclusion: Pedal Doppler US shows considerable promise as a rapid, non-invasive, and accessible preliminary screening tool for irregular arrhythmias in podiatric settings. With appropriate training to standardize interpretation, podiatrists could play a pivotal role in opportunistic AF detection, facilitating timely ECG referral and potentially reducing stroke incidence in at-risk populations. Larger-scale, multi-center studies are recommended to validate these findings and inform future clinical guidelines.