IMPACT OF SIGNAL LOSS ON THE DETECTION OF PAROXYSMAL ATRIAL FIBRILLATION IN A IN-HOUSE STROKE UNIT CARDIAC MONITORING SERVICE

Background and Purpose. Paroxysmal Atrial fibrillation/Flutter (PAF) detection rates in cryptogenic strokes have been variable. We sought to determine the percentage of patients with cryptogenic stroke who had PAF on prolonged non-invasive cardiac monitoring.Methods and Results. Sixty-two consecutive patients with stroke and TIA in a single center with a mean age of 61 (+/− 14) years were analyzed. PAF was detected in 15 (24%) patients. Only one patient reported symptoms of shortness of breath during the episode of PAF while on monitoring, and 71 (97%) of these 73 episodes were asymptomatic. A regression analysis revealed that the presence of PVCs (ventricular premature beats) lasting more than 2 minutes (OR 6.3, 95% CI, 1.11–18.92;P=.042) and strokes (high signal on Diffusion Weighted Imaging) (OR 4.3, 95% CI, 5–36.3;P=.041) predicted PAF. Patients with multiple DWI signals were more likely than solitary signals to have PAF (OR 11.1, 95% CI, 2.5–48.5,P<.01).Conclusion. Occult PAF is common in cryptogenic strokes, and is often asymptomatic. Our data suggests that up to one in five patients with suspected cryptogenic strokes and TIAs have PAF, especially if they have PVCs and multiple high DWI signals on MRI.

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Abstract 3648: Detection Of Paroxysmal Atrial Fibrillation In Patient With Acute Brain Ischemia Combining Cardiac And Holter Monitoring: Prevalence And Predictors

Stroke ◽

10.1161/str.43.suppl_1.a3648 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Patricia Martinez-Sanchez ◽

Elisa Correas Callero ◽

Andres Cruz Herranz ◽

Blanca Fuentes Gimeno ◽

Angel Martin Montes ◽

...

Keyword(s):

Atrial Fibrillation ◽

Brain Ischemia ◽

Paroxysmal Atrial Fibrillation ◽

Left Atrial ◽

Duplex Ultrasound ◽

Unknown Origin ◽

Holter Monitoring ◽

Cardiac Monitoring ◽

Stroke Severity ◽

Carotid Plaques

INTRODUCTION: The yield of serial electrocardiograms (ECG) plus 72-hour cardiac monitoring and Holter monitoring in detection of paroxysmal atrial fibrillation (PAF) is not well known. METHODS: consecutive patients with stroke or transient ischemic attack (TIA) admitted to a Stroke Unit (SU) during January 2009-June 2010 were studied. Patients underwent serial ECG and cardiac monitoring in the first 72 hours. Furthermore, 24-hours Holter monitoring were performed in patient with brain ischemia of unknown origin or if cardiac embolism was suspected. The presence of atrial fibrillation (AF) and PAF was recorded. RESULTS: 537 patients were included, 59.6% males. Mean age 69.1 (SD 13.5) years. Previous AF was present in 15.8% patients. ECG on admission showed not previously known AF in 22 (4%) patients. Cardiac monitoring and serial ECG in the SU detected PAF in 12 (2.2%) cases more. 24-hours Holter monitoring was completed in 156 patients, in 42 cases PFA was detected, of them 6 had been previously detected by serial ECG/cardiac monitoring. One case of PAF detected by serial ECG was not confirmed by Holter monitoring. In total, 10.8% of patients were diagnosed with new PAF. In multivariate analyses, NIHSS on admission (OR 1.1 for each 1 point increase; 95% CI, 1-1.2), enlarged left atrial (OR 5.8; 95% CI, 2.8-12), absence of carotid plaques by duplex ultrasound (OR 2.1; 95% CI 1-4.4) and hyperlipidemia (OR 2.4; 95% CI 1.119-5) were predictors of PAF. CONCLUSIONS: 24-hours Holter monitoring increased by 6 fold the detection of PAF as compared to ECG plus cardiac monitoring in acute stroke patients. Stroke severity, enlarged left atrial, absence of carotid plaques and hyperlipidemia are associated with PAF.

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A Simple Score That Predicts Paroxysmal Atrial Fibrillation on Outpatient Cardiac Monitoring after Embolic Stroke of Unknown Source

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2018.01.028 ◽

2018 ◽

Vol 27 (6) ◽

pp. 1692-1696 ◽

Cited By ~ 9

Author(s):

Brittany Ricci ◽

Andrew D. Chang ◽

Morgan Hemendinger ◽

Katarina Dakay ◽

Shawna Cutting ◽

...

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Embolic Stroke ◽

Cardiac Monitoring ◽

Unknown Source

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Letter by Diomedi et al Regarding Article “Continuous Stroke Unit Electrocardiographic Monitoring Versus 24-Hour Holter Electrocardiography for Detection of Paroxysmal Atrial Fibrillation After Stroke”

Stroke ◽

10.1161/strokeaha.112.681072 ◽

2013 ◽

Vol 44 (2) ◽

Author(s):

Marina Diomedi ◽

Silvia Di Legge ◽

Fabrizio Sallustio

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Stroke Unit ◽

Electrocardiographic Monitoring

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Recurrences in the Blanking Period and 12-Month Success Rate by Continuous Cardiac Monitoring After Cryoablation of Paroxysmal and Non-Paroxysmal Atrial Fibrillation

Journal of Cardiovascular Electrophysiology ◽

10.1111/jce.13190 ◽

2017 ◽

Vol 28 (6) ◽

pp. 625-633 ◽

Cited By ~ 9

Author(s):

PAOLO PIERAGNOLI ◽

ALESSANDRO PAOLETTI PERINI ◽

GIUSEPPE RICCIARDI ◽

LUCA CHECCHI ◽

ANDREA GIOMI ◽

...

Keyword(s):

Atrial Fibrillation ◽

Success Rate ◽

Paroxysmal Atrial Fibrillation ◽

Cardiac Monitoring

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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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