Document Detail


Enhanced detection of paroxysmal atrial fibrillation by early and prolonged continuous holter monitoring in patients with cerebral ischemia presenting in sinus rhythm.
MedLine Citation:
PMID:  20966415     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Diagnosis of paroxysmal atrial fibrillation is difficult but highly relevant in patients presenting with cerebral ischemia yet free from atrial fibrillation on admission. Early initiation and prolongation of continuous Holter monitoring may improve diagnostic yield compared with the standard of care including a 24-hour Holter recording.
METHODS: In the observational Find-AF trial (ISRCTN 46104198), consecutive patients presenting with symptoms of cerebral ischemia were included. Patients free from atrial fibrillation at presentation received 7-day Holter monitoring.
RESULTS: Two hundred eighty-one patients were prospectively included. Forty-four (15.7%) had atrial fibrillation documented by routine electrocardiogram on admission. All remaining patients received Holter monitors at a median of 5.5 hours after presentation. In those 224 patients who received Holter monitors but had no previously known paroxysmal atrial fibrillation, the detection rate with early and prolonged (7 days) Holter monitoring (12.5%) was significantly higher than for any 24-hour (mean of 7 intervals: 4.8%, P = 0.015) or any 48-hour monitoring interval (mean of 6 intervals: 6.4%, P = 0.023). Of those 28 patients with new atrial fibrillation on Holter monitoring, 15 (6.7%) had been discharged without therapeutic anticoagulation after routine clinical care (ie, with data from 24-hour Holter monitoring only). Detection rates were 43.8% or 6.3% for short supraventricular runs of ≥ 10 beats or prolonged episodes (> 5 hours) of atrial fibrillation, respectively. Diagnostic yield appeared to be only slightly and not significantly increased during the first 3 days after the index event.
CONCLUSIONS: Prolongation of Holter monitoring in patients with symptoms of cerebral ischemic events increases the rate of detection of paroxysmal atrial fibrillation up to Day 7, leading to a relevant change in therapy in a substantial number of patients. Early initiation of monitoring does not appear to be crucial. Hence, prolonged Holter monitoring (≥ 7 days) should be considered for all patients with unexplained cerebral ischemia.
Authors:
Raoul Stahrenberg; Mark Weber-Krüger; Joachim Seegers; Frank Edelmann; Rosine Lahno; Beatrice Haase; Meinhard Mende; Janin Wohlfahrt; Pawel Kermer; Dirk Vollmann; Gerd Hasenfuss; Klaus Gröschel; Rolf Wachter
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-10-21
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  41     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-30     Completed Date:  2010-12-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2884-8     Citation Subset:  IM    
Affiliation:
Department of Cardiology and Pneumology, Universitätsmedizin Göttingen, 37075 Göttingen, Germany. wachter@med.uni-goettingen.de
Data Bank Information
Bank Name/Acc. No.:
ISRCTN/ISRCTN46104198
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MeSH Terms
Descriptor/Qualifier:
Aged
Arrhythmia, Sinus / complications*,  diagnosis*
Atrial Fibrillation / diagnosis*
Biological Markers
Brain Ischemia / complications*
Cohort Studies
Electrocardiography
Electrocardiography, Ambulatory*
Feasibility Studies
Female
Humans
Male
Prospective Studies
Chemical
Reg. No./Substance:
0/Biological Markers

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