Document Detail

Continuous stroke unit electrocardiographic monitoring versus 24-hour Holter electrocardiography for detection of paroxysmal atrial fibrillation after stroke.
MedLine Citation:
PMID:  22871678     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Cardioembolism in paroxysmal atrial fibrillation (pxAF) is a frequent cause of ischemic stroke. Sensitive detection of pxAF after stroke is crucial for adequate secondary stroke prevention; the optimal diagnostic modality to detect pxAF on stroke units is unknown. We compared 24-hour Holter electrocardiography (ECG) with continuous stroke unit ECG monitoring (CEM) for pxAF detection.
METHODS: Patients with acute ischemic stroke or transient ischemic attack were prospectively enrolled. After a 12-channel ECG on admission, all patients received 24-hour Holter ECG and CEM. Additionally, ECG monitoring data underwent automated analysis using dedicated software to identify pxAF. Patients with a history of atrial fibrillation or with atrial fibrillation on the admission ECG were excluded.
RESULTS: Four hundred ninety-six patients (median age, 69 years; 61.5% male) fulfilled all inclusion criteria (ischemic stroke: 80.4%; transient ischemic attack: 19.6%). Median stroke unit stay lasted 88.8 hours (interquartile range, 65.0-122.0). ECG data for automated CEM analysis were available for a median time of 64.0 hours (43.0-89.8). Paroxysmal AF was documented in 41 of 496 patients (8.3%). Of these, Holter detected pxAF in 34.1%; CEM in 65.9%; and automated CEM in 92.7%. CEM and automated CEM detected significantly more patients with pxAF than Holter (P<0.001), and automated CEM detected more patients than CEM (P<0.001).
CONCLUSIONS: Automated analysis of CEM improves pxAF detection in patients with stroke on stroke units compared with 24-hour Holter ECG. The comparative usefulness of prolonged or repetitive Holter ECG recordings requires further evaluation.
Timolaos Rizos; Janina Güntner; Ekkehart Jenetzky; Lars Marquardt; Christine Reichardt; Rüdiger Becker; Roland Reinhardt; Thomas Hepp; Paulus Kirchhof; Elena Aleynichenko; Peter Ringleb; Werner Hacke; Roland Veltkamp
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-08-07
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  43     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-25     Completed Date:  2013-01-17     Revised Date:  2013-02-28    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2689-94     Citation Subset:  IM    
Department of Neurology, University Heidelberg, INF 400, 69120 Heidelberg, Germany.
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MeSH Terms
Atrial Fibrillation / complications,  diagnosis*,  physiopathology
Electrocardiography, Ambulatory / instrumentation,  methods*
Hospital Units*
Ischemic Attack, Transient / etiology,  prevention & control
Middle Aged
Monitoring, Physiologic / instrumentation,  methods*
Prospective Studies
Risk Factors
Secondary Prevention
Stroke / etiology,  prevention & control*
Time Factors
Comment In:
Stroke. 2013 Feb;44(2):e8   [PMID:  23299496 ]
Stroke. 2012 Oct;43(10):2541-2   [PMID:  22871685 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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