Document Detail

Detection of paroxysmal atrial fibrillation with transtelephonic EKG in TIA or stroke patients.
MedLine Citation:
PMID:  20498434     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Paroxysmal atrial fibrillation (PAF) may remain underdiagnosed after stroke, as suggested by long-duration EKG monitoring. Here we report the sensitivity of transtelephonic EKG monitoring (TTM) for detection of PAF in patients following a recent stroke or TIA and a negative 24-hour Holter. METHODS: We analyzed data from 98 consecutive patients with TTM and noncardioembolic TOAST stroke (n = 78) or TIA (n = 20). Most were cryptogenic events (82%). Patients started TTM 0.8 months (interquartile range 0.4-2.5) after the indexed event and randomly recorded about 1 EKG per day for 1 month. Univariate and multivariate analyses were run to identify PAF predictors. RESULTS: Seventeen PAF episodes were detected in 9.2% (9/98) of the patients. The estimated duration of PAF episodes ranged from 4 to 72 hours. Two predictors were identified: premature atrial ectopic beats (more than 100) in 24-hour routine Holter (odds ratio [OR] = 11.0; 95% confidence interval [CI] 1.9-62; p = 0.007) and nonlacunar anterior circulation DWI hypersignals (OR = 9.9; 95% CI 1.1-90.6; p = 0.04). The PAF detection rate varied from 42.6% for patients meeting both criteria to 0% for patients with neither of them. CONCLUSIONS: Transtelephonic EKG monitoring increases detection rate of paroxysmal atrial fibrillation in stroke and TIA patients whose 24-hour Holter result was negative, especially if they had frequent premature atrial ectopic beats, recent anterior circulation infarct on MRI, or both.
N Gaillard; S Deltour; B Vilotijevic; A Hornych; S Crozier; A Leger; R Frank; Y Samson
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neurology     Volume:  74     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-25     Completed Date:  2010-06-15     Revised Date:  2010-06-29    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1666-70     Citation Subset:  AIM; IM    
APHP Urgences C?r?brovasculaires, H?pital Piti?-Salp?tri?re et UMPC Paris Universitas, 75013 Paris, France.
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MeSH Terms
Atrial Fibrillation / diagnosis*,  etiology*
Electrocardiography / methods*
Ischemic Attack, Transient / complications*
Logistic Models
Middle Aged
Retrospective Studies
Stroke / complications*
Telemetry / methods*
Comment In:
Neurology. 2010 May 25;74(21):1662-3   [PMID:  20498433 ]
J Neurol. 2010 Jul;257(7):1221-3   [PMID:  20559840 ]

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