Gapless Electrocardiogram-Monitoring in stroke at high risk of atrial fibrillation.

Autor: Burger AL; Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.; Department of Neurology, Medical University of Vienna, Vienna, Austria., Roesler C; Department of Neurology, Medical University of Salzburg, Salzburg, Austria., Ebner J; Department of Neurology, Medical University of Vienna, Vienna, Austria., Sommer P; Department of Neurology, Clinic Landstrasse, Vienna, Austria., Mutzenbach S; Department of Neurology, Medical University of Salzburg, Salzburg, Austria., Winkler WB; Department of Cardiology, Clinic Landstrasse, Vienna, Austria., Weidinger F; Department of Cardiology, Clinic Landstrasse, Vienna, Austria., Ristl R; Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria., Pezawas T; Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria., Greisenegger S; Department of Neurology, Medical University of Vienna, Vienna, Austria.
Jazyk: angličtina
Zdroj: European journal of neurology [Eur J Neurol] 2023 Jul; Vol. 30 (7), pp. 2092-2098. Date of Electronic Publication: 2023 Feb 24.
DOI: 10.1111/ene.15741
Abstrakt: Background and Purpose: Previous studies investigating prolonged electrocardiogram (ECG)-monitoring after ischemic stroke had significant gaps between the index event and the beginning of long-term monitoring. Atrial fibrillation (AF) detection might be higher if prolonged cardiac rhythm documentation is performed with a gapless approach without any interruption of monitoring time.
Methods: This investigator-initiated, prospective study included patients with acute ischemic stroke or transient ischemic attack at three study centers. Participants received gapless ECG-monitoring via telemetry during stroke-unit admission until implantation of an insertable cardiac monitor (ICM) within the first days after the index event. Patients acted as their own controls and also received standard 24-72-h Holter ECG.
Results: A total of 110 patients were included, of whom 86 (78.2%) had an embolic stroke of unknown source, 14 (12.7%) had small-vessel disease, and 10 (9.1%) had large-artery disease. AF was newly diagnosed in 17 (15.5%) patients via ICM monitoring, compared to one (0.9%) patient via Holter ECG during 6 months of follow-up (p < 0.001). The detection rate of AF within the first 30 days was 10.0%, which accounted for 64% of all new AF diagnoses. The median duration of the detected episodes was 1.7 (interquartile range = 0.2-4.7) h. All patients with new onset AF were treated with oral anticoagulation.
Conclusions: Gapless ECG-monitoring is an effective strategy to significantly increase the detection rate of AF after ischemic stroke. This finding supports the use of long-term ECG-monitoring with a gapless approach without any interruption in monitoring time as the gold standard for clinical practice.
(© 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)
Databáze: MEDLINE
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