BackgroundPulse palpation is recommended for single time-point screening for atrial fibrillation (AF). The role of pulse palpation for AF detection has not been validated against simultaneous intermittent ECG recordings. We aimed to study the validity of AF screening using self-pulse palpation simultaneously with handheld ECG recordings three times daily for two weeks for AF. Methods and FindingsPatients 65 years of age and older visiting four primary care centres were invited to take part in AF screening from July 2017 to December 2018. Handheld intermittent ECGs three times per day were offered to patients without AF for a period of 2 weeks and patients were instructed on how to take their own pulse simultaneously. A total of 1010 patients (mean age 73 years, 61% female) participated in the study and 27 (2.7%) new cases of AF were detected. A total of 53782 simultaneous ECG recordings and pulse measurements were registered. AF was verified in 311 ECG recordings, of which the pulse was palpated as irregular in 77 patients (25% sensitivity per measurement occasion). Of the 27 AF cases, 15 cases felt an irregular pulse on at least at one occasion (56% sensitivity per individual). 187 individuals without AF felt an irregular pulse on least one occasion. The specificity per measurement occasion and per individual was 98% and 81%, respectively. ConclusionAF screening using self-pulse palpation three times daily for two weeks has lower sensitivity compared with simultaneous intermittent ECG.