Longer duration of electrocardiographic monitoring after cryptogenic stroke is associated with a greater detection of AF .
BACKGROUND Atrial fibrillation ( AF ) is a major cause of stroke .
Although st and ard investigations after an event include electrocardiographic monitoring , the optimal duration to detect AF is unclear .
We performed a systematic review and meta- analysis to determine whether the duration of electrocardiographic monitoring after an ischemic event is related to the detection of AF .
Detection of Paroxysmal Atrial Fibrillation in Acute Stroke Patients
Background : Atrial fibrillation ( AF ) is a frequent cause of stroke , but detecting paroxysmal AF ( pAF ) poses a challenge . We investigated whether continuous bedside ECG monitoring in a stroke unit detects pAF more sensitively than 24-hour Holter ECG , and tested whether examining RR interval dynamics on short-term ECG recordings using an automated screening algorithm ( ASA ) for pAF detection is a useful tool to predict the risk of pAF outside periods of manifest AF . Methods : Patients > 60 years with acute ischemic stroke or transient ischemic attacks ( TIA ) were prospect ively enrolled unless initial ECG revealed AF or they had a history of paroxysmal or persistent AF . ASA was performed on 1- to 2-hour ECG recordings in the emergency room and patients were classified into 5 risk categories for pAF . All patients underwent continuous bedside ECG monitoring for > 48 h. Additionally , 24-hour Holter ECG was performed . Results : 136 patients were enrolled ( median age : 72 years , male : 58.8 % ) . In 29 ( 21.3 % ) , pAF was newly diagnosed by continuous bedside ECG monitoring . pAF increased with age ( p = 0.031 ) . Median time to first pAF detection on continuous bedside ECG monitoring was 36 h. In 16 patients , pAF was detected by continuous bedside ECG monitoring prior to the performance of 24-hour Holter ECG . Thirteen of the remaining patients were pAF positive on continuous bedside ECG monitoring , but 24-hour Holter detected only 3 patients . Accordingly , the sensitivity of 24-hour Holter was 0.23 . Sensitivity of higher-risk categories of ASA compared to continuous bedside ECG monitoring was 0.72 , and specificity 0.63 . Conclusion : Continuous bedside ECG monitoring is more sensitive than 24-hour Holter ECG for pAF detection in acute stroke/TIA patients . Screening patients for pAF outside AF episodes using ASA requires further development
Longer duration of electrocardiographic monitoring after cryptogenic stroke is associated with a greater detection of AF .
BACKGROUND Atrial fibrillation ( AF ) is a major cause of stroke .
Although st and ard investigations after an event include electrocardiographic monitoring , the optimal duration to detect AF is unclear .
We performed a systematic review and meta- analysis to determine whether the duration of electrocardiographic monitoring after an ischemic event is related to the detection of AF .