Abstract 131: Continuous Stroke Unit ECG Monitoring is better than 24-h Holter ECG for Detection of Paroxysmal Atrial Fibrillation after Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Roland Veltkamp ◽  
Janina Guentner ◽  
Ekkehart Jenetzky ◽  
Ruediger Becker ◽  
Paulus Kirchhof ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Stroke Unit ◽  
Standard Procedure ◽  
Automated Analysis ◽  
Tertiary Hospital ◽  
Ecg Monitoring ◽  
Diagnostic Modality ◽  
Holter Ecg ◽  
Single Centre Study

Background and purpose: Cardioembolism in paroxysmal atrial fibrillation (pxAF) is a frequent cause of ischemic stroke (IS). Sensitive detection of pxAF after stroke is crucial for adequate secondary stroke prevention; the optimal diagnostic modality is unknown. To compare 24h-Holter ECG, the standard tool to detect pxAF, with continuous stroke unit ECG monitoring (CEM) for pxAF detection. Methods: Prospective single centre study of consecutive patients with acute IS or transient ischemic attack (TIA) admitted to a stroke unit of a tertiary hospital. Main outcome measures: Yield of pxAF detection by 12-channel ECG on admission, admission ECG plus 24h-Holter ECG, admission ECG plus CEM and admission ECG plus automated analysis of ECG monitoring data using a dedicated software to identify pxAF (aCEM). Results: 579 patients (median age 71, 59.8% male) fulfilled predefined inclusion criteria (IS: 81.3%; TIA: 18.7%). Median stroke unit stay lasted 89.8h (65.5-122.5). ECG data for aCEM analysis were available for a median time of 64h (43-91). In 130 patients (22.5%) AF was diagnosed; of which 73 (12.6%) showed persistent AF and 57 (9.8%) pxAF. Admission ECG discovered pxAF in 16/57 (28.1%). Admission ECG plus 24h-Holter ECG identified 31/57 (54.4%). Admission ECG plus CEM without automated analysis was significantly more effective (40/57; 70.1%) than admission ECG plus 24h-Holter ECG. Combining admission ECG and aCEM provided an even better detection rate (55/57; 96.5%; p<0.001). Conclusions: CEM can replace 24h-Holter ECGs as the standard procedure for evaluation for pxAF on stroke units.

scholarly journals 0059: Incidence and predictors of new-onset atrial fibrillation in septic shock patients in a medical ICU: data from 7-day Holter ECG monitoring

2015 ◽  
Vol 7 (1) ◽  
pp. 58
Author(s):  
Charles Guenancia ◽  
Christine Binquet ◽  
Gabriel Laurent ◽  
Sandrine Vinault ◽  
Rémi Bruyère ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Septic Shock ◽  
Ecg Monitoring ◽  
Holter Ecg ◽  
Onset Atrial Fibrillation ◽  
New Onset

Relevance of supraventricular runs detected after cerebral ischemia

Neurology ◽  
2017 ◽  
Vol 89 (15) ◽  
pp. 1545-1552 ◽  
Author(s):  
Mark Weber-Krüger ◽  
Constanze Lutz ◽  
Antonia Zapf ◽  
Raoul Stahrenberg ◽  
Joachim Seegers ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cerebral Ischemia ◽  
Ecg Monitoring ◽  
Holter Ecg ◽  
Acute Cerebral Ischemia ◽  
Temporal Phenomenon ◽  
Long Term Follow Up ◽  
Recurrent Strokes

Objective:Prolonged ECG monitoring after stroke frequently reveals short paroxysmal atrial fibrillation (pAF) and supraventricular (SV) runs. The minimal duration of atrial fibrillation (AF) required to induce cardioembolism, the relevance of SV runs, and whether short pAF results from cerebral damage itself are currently being debated. We aimed to study the relevance of SV runs and short pAF detected by prolonged Holter ECG after cerebral ischemia during long-term follow-up.Methods:Analysis is from the prospective Find-AF trial (ISRCTN46104198). We included patients with acute cerebral ischemia. Those without AF on admission received 7-day Holter ECG monitoring. We differentiated patients with AF on admission (AF-adm), with pAF (>30 seconds), with SV runs (>5 beats but <30 seconds in a 24-hour ECG interval), and without SV runs (controls). During follow-up, those with baseline pAF received another 7-day Holter ECG to examine AF persistence.Results:A total of 254 of 281 initially included patients were analyzed (mean age 70.0 years, 45.3% female). Forty-three (16.9%) had AF-adm. A total of 211 received 7-day Holter ECG monitoring: 27 (12.8%) had pAF, 67 (31.8%) had SV runs, and 117 (55.5%) were controls. During a mean 3.7 years of follow-up, the SV runs group had more recurrent strokes (p = 0.04) and showed numerically more novel AF (12% vs 5%, p = 0.09) than the controls. Seventy-five percent of the patients with manifest pAF detected after cerebral ischemia still had AF during follow-up (50% paroxysmal, 50% persisting/permanent).Conclusions:Patients with cerebral ischemia and SV runs had more recurrent strokes and numerically more novel AF during follow-up and could benefit from further prolonged ECG monitoring. pAF detected after stroke is not a temporal phenomenon.

Abstract WP135: Sinus Bradycardia as a Potential Predictive Factor for Paroxysmal Atrial Fibrillation in Stroke Patients

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Takao Hoshino ◽  
Kentaro Ishiduka ◽  
Takehiko Nagao ◽  
Satoru Shimizu ◽  
Shinichiro Uchiyama
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Predictive Factors ◽  
Predictive Factor ◽  
Paroxysmal Atrial Fibrillation ◽  
Multiple Logistic Regression Analysis ◽  
Previous History ◽  
Stroke Patients ◽  
Holter Ecg ◽  
Significant Difference

Background and Purpose The detection rate of paroxysmal atrial fibrillation (PAF) in stroke patients is limited because they are often asymptomatic, or presenting sinus rhythm on ECG. To estimate the likelihood of PAF as a cause of ischemic stroke, we attempted to identify predictive factors for PAF using the data of sinus heart rate (SHR) on monitoring ECG. Methods We enrolled 711 consecutive patients admitted to our hospital with acute ischemic stroke. Exclusion criteria were (1) persistent AF; (2) cardiac pacemaker; and (3) incomplete clinical investigations. Minimum and mean SHR on 24-hour Holter ECG were obtained. The presence of PAF was judged based on previous history, initial ECG, 24-hour Holter ECG, and cardiac monitoring by inpatient telemetry. The clinical characteristics were compared between patients with and without PAF (PAF and non-PAF group, respectively), and multiple logistic regression analysis was performed to identify predictors for PAF. Results Of all enrolled patients, 577 patients were eligible for analysis, and PAF was confirmed in 110 (19.1%). Clinical parameters showing a significant difference between PAF and non-PAF groups included: age (mean, 74.1 vs. 66.6, P <0.001); dyslipidemia (32.7% vs. 50.8%, P =0.001); lack of intra- or extracranial stenosis (54.0% vs. 79.1%, P <0.001); chronic heart failure (17.3% vs. 4.9%, P <0.001); and NIHSS score (median, 8 vs. 6, P =0.002). Minimum and mean SHR were lower in PAF group than in non-PAF group (46.4 vs. 54.1 bpm, P <0.001; 71.0 vs. 73.8 bpm, P =0.021, respectively). Percentages of patients with PAF were highest in the lowest quartiles of minimum and mean SHR (Figure). Multivariate analysis showed minimum SHR as one of independent predictive factors of PAF (OR 1.08; 95% CI 1.05 to 1.12; P <0.001). Conclusions Low SHR on monitoring ECG can be a novel predictive factor for PAF in ischemic stroke patients.

scholarly journals Burden of premature atrial beats in middle-aged endurance athletes with and without lone atrial fibrillation versus sedentary controls

2019 ◽  
Vol 27 (14) ◽  
pp. 1555-1563
Author(s):  
Alberto Cipriani ◽  
Riccardo Vio ◽  
Giulio Mastella ◽  
Nicolò Ciarmatori ◽  
Alvise Del Monte ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Multivariable Analysis ◽  
Endurance Athletes ◽  
Ecg Monitoring ◽  
Middle Aged ◽  
Sports Activity ◽  
Lone Atrial Fibrillation ◽  
Aged Patients ◽  
And Gender

Background The burden of premature atrial beats (PABs) at 24-h electrocardiographic (ECG) monitoring correlates with the risk of atrial fibrillation. It is unknown whether prolonged and intense exercise increases the burden of PABs, thus contributing to the higher prevalence of atrial fibrillation observed in middle-aged athletes. Methods We compared the burden of PABs at 24-h ECG monitoring off therapy in 134 healthy middle-aged (30–60-year-old) competitive athletes who had practised 9 (7-11) h of endurance sports for 8 (4-15) consecutive years, 134 age- and gender-matched healthy sedentary individuals, and 66 middle-aged patients (20 athletes and 46 non-athletes) with ‘lone’ paroxysmal atrial fibrillation. Results More than 50 PABs/24 h or ≥1 run of ≥3 PABs were recorded in 23/134 (17%) healthy athletes and in 29/134 (22%) sedentary controls ( p = 0.61). Healthy athletes with frequent or repetitive PABs were older (median 50 years vs. 43 years, p < 0.01) and had practised sport for a longer time (median 10 years vs. 6 years, p = 0.03). At multivariable analysis only age (odds ratio 1.11, 95% confidence interval 1.04–1.20, p < 0.01) remained an independent predictor of a higher burden of PABs. Also among patients with ‘lone’ paroxysmal atrial fibrillation, there was no difference in the prevalence of >50 PABs/24 h or ≥1 run of ≥3 PABs between athletes (40%) and controls (48%, p = 0.74) . Conclusions Middle-aged endurance athletes, with or without paroxysmal atrial fibrillation, did not show a higher burden of PABs at 24-h ECG monitoring than sedentary controls. Age, but not intensity and duration of sports activity, predicted a higher burden of PABs among healthy athletes.

Abstract TP231: Echocardiographically Identified Left Atrial Enlargement is Associated With Non-valvular Paroxysmal Atrial Fibrillation (PAF) and is a Surrogate for PAF Associated Risk for Embolic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Adeniyi O Molajo
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Stroke Risk ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Ecg Monitoring ◽  
Ambulatory Ecg ◽  
Ambulatory Ecg Monitoring

Introduction: Paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation are risk factors for systemic embolism including stroke. Both are indication for anticoagulation. Many patients with stroke in sinus rhythm are shown on ambulatory ECG monitoring to have PAF. PAF is difficult to diagnose on ambulatory ECG monitoring. A persistent marker for PAF will be useful to identify need for anticoagulant to reduce stroke risk due to PAF. Echocardiographic variable with a high predictive value for PAF is desirable. Objective: The purpose of the study was to investigate the relationship between left atrial (LA) size and proneness to paroxysmal atrial fibrillation and assess its reliability as a surrogate for diagnosing non valvular PAF. Method: Echo Database for patients with measured LA volume index, in sinus rhythm without history of intervention for atrial fibrillation, pharmacological therapy, and cardioversion or ablation therapy over a seven year period was reviewed. Patients with enlarged LA Volume index (>28ml/M 2 ) were selected. Seven Day ambulatory ECG monitoring was performed in these patients, ResultEchocardiogram data of 245 patients were available for analysis. 41 had greater than mild mitral valve regurgitation and were excluded from further analysis. Age range was 37-93. 99 were male. 211 patients had LA volume index data available. In 8 patients in sinus rhythm on ambulatory ECG, LA volume index was mildly increased (28-34 ml/M 2) In 16 patients with PAF on ambulatory ECG, LA volume index was mildly increased (28-34 ml/M 2 ) In 100 patients with PAF on ambulatory ECG, LA volume index was moderately increased (35-40 ml/M 2 ) In 88 patients with PAF on ambulatory ECG, LA volume index was severely increased (>40 ml/M 2 ) Conclusion: In patients with moderately and severely enlarged LA volume index, there was a high prevalence of paroxysmal atrial fibrillation on ambulatory ECG monitoring. Left Atrial volume index could serve as an echocardiographic surrogate for PAF and identify indication for anticoagulation to reduce stroke risk. It Is More Easily Identifiable Surrogate For PAF Than Ambulatory ECG Monitoring In Stroke Risk Assessment.

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