Delayed Detection of Atrial Fibrillation after Ischemic Stroke

Kamel, Hooman; Lees, Kennedy R.; Lyden, Patrick D.; Teal, Philip; Shuaib, Ashfaq; Ali, Myzoon; Johnston, S. Claiborne

doi:10.1016/j.jstrokecerebrovasdis.2009.01.012

Cited by 45 publications

(34 citation statements)

References 24 publications

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“…In this study, we found 7.24% new AF patients in first-24-hour hCEM. Detection rates using hCEM or aCEM are consistent with existing evidence suggesting that early and prolonged monitoring is associated with an increased AF detection rate compared to routine 24-hour Holter ECG [4,7,8,16,17,18,19]. Recent guidelines recommended the use of CEM at least 24 h in cardiac workup after stroke [5].…”

Section: Discussionsupporting

confidence: 73%

“…Anticoagulant treatment, with vitamin K antagonists or new oral anticoagulants, dramatically reduces the risk of recurrent stroke [3]. The difficulty of occult AF detection after stroke leads to underestimation of AF prevalence and underutilization of anticoagulants in secondary prevention of stroke [4]. The optimal cardiac workup to diagnose paroxysmal AF is currently unclear.…”

Section: Introductionmentioning

confidence: 99%

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Continuous ECG Monitoring for Tracking Down Atrial Fibrillation after Stroke: Holter or Automated Analysis Strategy?

Suissa¹,

Lachaud²,

Mahagne³

2014

Eur Neurol

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Background: Tracking down atrial fibrillation (AF) in the stroke unit is a relevant challenge for the prevention of recurrent AF-related stroke. The optimal terms of use of continuous ECG monitoring (CEM) are unknown. We compared 24-hour routine Holter ECG with two different CEM analysis strategies for AF detection. Methods: We prospectively enrolled consecutive ischemic stroke patients. All AF-naïve patients received CEM during hospitalization. Two methods for reading CEM data were compared: manual analysis using the Holter function (hCEM) and semiautomated analysis using software (aCEM). The McNemar test was used to compare AF detection rates. Results: Of the 362 patients included, 58 (16.0%) were non-AF-naïve patients and 304 were AF-naïve patients. AF-Naïve patients underwent CEM with a median duration of 5.3 days (3.4-9.7). We detected 22 new AF cases (7.2%) with first-24-hour hCEM, 31 (10.2%) with aCEM, and 42 (13.8%) with hCEM. hCEM and aCEM both significantly increased the AF detection rate compared to first-24-hour hCEM. hCEM detected more new AF cases than aCEM (+3.6%, p = 0.003). Conclusions: In stroke patients, early and prolonged aCEM and hCEM both increase the AF detection rate compared to first-24-hour hCEM. hCEM gives the best AF detection rate. We suggest that in aCEM, detection based only on the ventricular rhythm analysis explains its lower specificity and sensitivity.

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Continuous ECG Monitoring for Tracking Down Atrial Fibrillation after Stroke: Holter or Automated Analysis Strategy?

Suissa¹,

Lachaud²,

Mahagne³

2014

Eur Neurol

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“…17,18 Ongoing studies are evaluating these technologies and implanted long-term ECG monitors (eg, Study of Continuous Cardiac Monitoring to Assess Atrial Fibrillation After Cryptogenic Stroke [CRYSTAL AF], NCT00924638) in stroke survivors in multicenter settings close to clinical practice. Additional fishing grounds have also been probed, at least in preliminary data sets: A patient-operated ECG system similar to the one used by Engdahl and colleagues identified silent AF in patients who seek medical help for the treatment of hypertension, diabetes mellitus, or stroke, especially in those who accumulate several stroke risk factors.…”

Section: Ahmad and Kirchhof Gone Fishing (For Silent Atrial Fibrillatmentioning

confidence: 99%

Gone Fishing (for Silent Atrial Fibrillation)

Ahmad

Kirchhof

2013

Circulation

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“…Reportedly, delayed detection of AF is common in patients with stroke. 12 Paroxysmal AF (pxAF) carries the same risk of cardioembolism as persistent AF, [13][14][15] and cardiogenic embolism due to undetected pxAF is probably responsible for a substantial part of cryptogenic ischemic strokes. 16 -18 Consequently, efforts to improve the detection of pxAF after a stroke are of great importance.…”

mentioning

confidence: 99%

Continuous Stroke Unit Electrocardiographic Monitoring Versus 24-Hour Holter Electrocardiography for Detection of Paroxysmal Atrial Fibrillation After Stroke

Rizos

Güntner

Jenetzky

et al. 2012

Stroke

188

142

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Background and Purpose-Cardioembolism in paroxysmal atrial fibrillation (pxAF) is a frequent cause of ischemic stroke. Sensitive detection of pxAF after stroke is crucial for adequate secondary stroke prevention; the optimal diagnostic modality to detect pxAF on stroke units is unknown. We compared 24-hour Holter electrocardiography (ECG) with continuous stroke unit ECG monitoring (CEM) for pxAF detection. Methods-Patients

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Delayed Detection of Atrial Fibrillation after Ischemic Stroke

Cited by 45 publications

References 24 publications

Continuous ECG Monitoring for Tracking Down Atrial Fibrillation after Stroke: Holter or Automated Analysis Strategy?

Continuous ECG Monitoring for Tracking Down Atrial Fibrillation after Stroke: Holter or Automated Analysis Strategy?

Gone Fishing (for Silent Atrial Fibrillation)

Continuous Stroke Unit Electrocardiographic Monitoring Versus 24-Hour Holter Electrocardiography for Detection of Paroxysmal Atrial Fibrillation After Stroke

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