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Objective To estimate the prevalence of unknown atrial fibrillation (AF) in the elderly population of the Veneto Region,Italy.Methods 1820 patients aged ≥ 65 years with no history of AF and not anticoagulated were enrolled in primary-care settings.They underwent an opportunistic electrocardiogram screening with a handheld device (MyDiagnostick) designed to specifically detect AE The electrocardiogram recordings were reviewed by the researchers,who confirmed the presence of AF.Results The device detected an arrhythmia in 143 patients,which was confirrned as AF in 101/143 (70.6％),with an overall prevalence of AF of 5.5％ (101/1820).Prevalence of unknown AF resulted in 3.6％ in patients aged 65-74 years,and 7.5％ in patients age 75 or older,and increased according to CHA2DS2-VASc score: 3.5％ in patients with a score of 1 or 2,5.6％ in patients with a score of 3,7.0％ in patients with a score of 4,and 7.2％ in patients with a score ≥ 5.The detection rate was significantly higher in patients with mild symptoms compared to asymptomatic counterparts (24.1％ vs.4.0％,P ＜ 0.0001).At multivariate analysis,congestive heart failure and age ≥ 75 years-old were independent predictors for screen-detected AF.Conclusions An opportunistic screening with handheld device revealed an unexpectedly high prevalence of unknown AF in elderly patients with mild symptoms.Prevalence increased with age and CHA2DS2-VASc score.