Detecting Atrial Fibrillation in Patients With an Embolic Stroke of Undetermined Source (from the DAF-ESUS registry)
| Autor: | José María Serratosa Fernández, José Tuñón Fernández, Loreto Bravo Calero, Pepa Sánchez Borque, Rafael Sáez Pinel, Ángel Miracle Blanco, Ivana Zamarbide Capdepón, Inmaculada Navas Vinagre, M Araceli García Torres, José Manuel Rubio Campal |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Atrial Fibrillation medicine Hospital discharge Humans In patient cardiovascular diseases Registries Prospective cohort study Subclinical infection Aged Retrospective Studies business.industry Incidence Reproducibility of Results Atrial fibrillation medicine.disease Prognosis Embolic stroke Intracranial Embolism Spain Cohort Cardiology Electrocardiography Ambulatory Female Cardiology and Cardiovascular Medicine business Holter monitoring 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | The American journal of cardiology. 125(3) |
| ISSN: | 1879-1913 |
| Popis: | Atrial fibrillation (AF) causes a substantial proportion of embolic strokes of undeterminded source (ESUS). Effective detection of subclinical AF (SCAF) has important therapeutic implications. We conducted a prospective study to determine the prevalence of SCAF in patients with ESUS through of a 21-day Holter monitoring. In an early-monitoring group, Holter was initiated immediately after hospital discharge. The results were compared with a previous cohort of patients in whom the Holter was initiated at least 1 week after hospital discharge (late-monitoring group). We included 100 patients (50 each group; 69 ± 13 years, 56% male). Mean time from ESUS to Holter was 1.2 ± 1 day in the early-monitoring group and 30 ± 15 days in the late-monitoring group. SCAF was detected in 22% of patients in the early-monitoring and 6% in the late-monitoring group (p0.05). Patients with SCAF were older (77 ± 9 vs 67 ± 11 years, p0.05), with a higher rate of left atrial enlargement (50% vs 20%, p0.05), renal impairment (28% vs 5%; p0.01), and a slower mean heart rate (55 ± 6 vs 70 ± 6 beats/min; p0.001). On multivariate analysis, the presence of persistent bradycardia (≤60 beats/min) in the 21-day Holter was a powerful and significant risk factor for SCAF. In conclusion, the sooner 21-day Holter electrocardiogram monitoring is initiated after ESUS, the more likely SCAF can be detected. Sinus bradycardia is a powerful predictor of SCAF in patients with ESUS. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect