Automatic detection of paroxysmal atrial fibrillation in patients with ischaemic stroke: better than routine diagnostic workup?

IntroductionIn this study, we aimed to investigate the usefulness of P wave peak time (PWPT), a novel ECG parameter, in patients who were diagnosed with acute ischaemic stroke (IS) and had paroxysmal atrial fibrillation (PAF) on Holter monitoring.Materials and methodsIn this retrospective cohort study, we included 90 consecutive patients with acute IS who were admitted to our hospital between January 2017 and July 2019. PWPT was described as the time from the beginning of the P wave to its peak, and it was measured from leads DII and VI. The PAF diagnosis was confirmed if it was detected on the ECG during palpitation or in rhythm during the Holter recordings.ResultsIn this study, 34 (37.7%) patients with acute IS were diagnosed with PAF. In multivariate analyses, the independent predictors of PAF were age, PWPT in lead VI and PWPT in lead DII (OR: 1.34, 95% CI 1.15 to 1.56; p<0.001). A receiver operating curve analysis demonstrated that area under the curve values for PWPT in lead DII for PAF were 0.88 (95% CI 0.81 to 0.95, p<0.001). The cut-off value for PWPT in lead DII in predicting PAF was 68.5 ms with a sensitivity of 82.4% and a specificity of 75.0%.ConclusionTo the best of our knowledge, this is the first study to demonstrate a significant relationship between PWPT in lead DII and PAF among patients with acute IS.

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Abstract WP229: Randomised Clinical Trial of Early Prolonged Ambulatory Cardiac monitoring After Stroke (EPACS): Interim Analysis

Stroke ◽

10.1161/str.48.suppl_1.wp229 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

James T Teo ◽

Judith Lenane ◽

Laszlo Sztriha ◽

Fong K Chan ◽

John Aeron-Thomas ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischaemic Stroke ◽

Paroxysmal Atrial Fibrillation ◽

Interim Analysis ◽

Controlled Trial ◽

Significant Proportion ◽

University Hospital ◽

Cardiac Monitoring ◽

Serious Adverse Events ◽

Index Event

Introduction: Cardioembolism in paroxysmal atrial fibrillation (PAF) is a preventable cause of ischaemic stroke or transient ischaemic attack (TIA), but the transient nature of PAF means that a short-duration Holter monitor misses a significant proportion of cases. Systems for recording beyond 3-7 days have significant limitations: event-triggered loop recorders are cumbersome while implanted loop recorders require a minor surgical procedure. There is a need for a patient-friendly long-duration cardiac monitoring system for stroke patients which can be performed without significant delay from the index event and with superior yield to Holter ECG’s. Methods: We conducted a pragmatic randomised controlled trial of cardiac monitoring after an ischaemic stroke or TIA to increase detection of paroxysmal atrial fibrillation (recruited within 72 hours of index event) using a wearable water-proof adhesive cardiac monitoring patch (Zio® Patch, iRhythm Technologies) that can be fitted immediately by the clinician early after the index event for up to 14 days or a standard Holter ECG. The trial aimed to recruit 120 patients across two locations - urban teaching hospital (Kings College Hospital, London) and suburban district hospital (Princess Royal University Hospital, Orpington). ISCRTN Registration 50253271. Results: In August 2016, the interim analysis detected PAF in 4/17 cases in the active arm and 0/16 cases in the control arm. The commonest arrhythmias detected were atrial tachyarrhythmias followed by PAF. Those in the control arm of Holter ECG’s had significant delays to initiate cardiac monitoring due to scheduling delays and patient non-attendance. There were no device-attributable serious adverse events. Further late-breaking results will be available in February 2017. Conclusion: The convenience of the Zio® Patch cardiac monitor substantially increased the uptake and efficiency of cardiac monitoring early after ischaemic strokes and TIA.

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