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.
Continuous Stroke Unit Electrocardiographic Monitoring Versus 24-Hour Holter Electrocardiography for Detection of Paroxysmal Atrial Fibrillation After Stroke
