Introduction:
Recent evidence has shown that prolonged cardiac monitoring is superior to 24 hour Holter for detection of atrial fibrillation (AF). We compared two methods of prolonged monitoring in patients with acute ischemic stroke and TIAs.
Objective:
Comparison of the Cardiophone and Sorin monitor for detection of AF.
Method:
In the first part of the study (PEAACE I; 2011-2013), we used the spiderflash (Sorin, Italy) for up to 21 days of monitoring. In the second part (PEAACE II; 2013-2015), Cardiophone with real time monitoring of the heart rhythm for 14 days was used.
Results:
102 patients in PEAACE I, (Mean age 72 +/-, 48.8% male) were compared to 120 patients in PEAACE II (Mean age 73 +/-, 70% male). Stroke type was “undetermined (cryptogenic) 92% and 91% in the two studies respectively. In PEAACE I, AF was detected in 43 out of 102 subjects (42%) (72% <30 seconds, 28% >30 seconds) with detection of 75% in the first week, 23% in the second, and 2% in the last week. In PEAACE II, 20 out of 120 subjects (17%) (70% <30 seconds, 30% >30 seconds) had AF, with 55% of detection in the first week, 45% in the second one (χ2 p=0.001). In PEAACE II, the results were available faster, within 2 days compared to 21 days in PEAACE I (χ2 p<0.0005). In PEAACE II, 90% of the patients received anticoagulation (93% of participants with A Fib <30 seconds, 83% with >30 seconds) compared to 77% in PEAACE I (68% with AF <30 seconds and 100% with AF >30 seconds) (χ2 p=0.021).
Conclusion:
There were significant differences noted in the rates of detection with the two techniques. Real-time monitoring resulted in recording of fewer events but lead to earlier initiation of treatment. All patients with >30 seconds of AF were anticoagulated whereas fewer patients with less than 30 seconds of AF were anticoagulated.
Real-time Validation of Transcranial Doppler Criteria in Assessing Recanalization During Intra-arterial Procedures for Acute Ischemic Stroke An International, Multicenter Study
