Detection of unknown atrial fibrillation by prolonged ECG monitoring in an all-comer patient cohort and association with clinical and Holter variables

Abstract

ObjectivesProlonged ECG monitoring is clinically useful to detect unknown atrial fibrillation (AF) in stroke survivors. The diagnostic yield of prolonged ECG monitoring in other patient populations is less well characterised. We therefore studied the diagnostic yield of prolonged Holter ECG monitoring for AF in an unselected patient cohort referred from primary care or seen in a teaching hospital.MethodsWe analysed consecutive 7-day ECG recordings in unselected patients referred from different medical specialities and assessed AF detection rates by indication, age and comorbidities.ResultsSeven-day Holter ECGs (median monitoring 127.5 hours, IQR 116 to 152) were recorded in 476 patients (mean age 54.6 (SD 17.0) years, 55.9% female) without previously known AF, requested to evaluate palpitations (n=241), syncope (n=99), stroke or transient ischaemic attack (n=75), dizziness (n=29) or episodic chest pain (n=32). AF was newly detected in 42/476 (8.8%) patients. Oral anticoagulation was initiated in 40/42 (95.2%) patients with newly detected AF. Multivariate logistic regression, adjusted for age, sex and monitoring duration found four clinical parameters to be associated with newly detected AF: hypertension OR=2.54, (1.08 to 8.61) (adjusted OR (95% CI)), p=0.034; previous stroke or TIA OR=4.14 (1.81 to 13.01), p=0.001; left-sided valvular heart disease OR=5.07 (2.48 to 18.70), p<0.001 and palpitations OR=2.86, (1.33 to 10.44), p=0.015.ConclusionsOpen multispeciality access to prolonged ECG monitoring, for example, as part of integrated, cross-sector AF care, can accelerate diagnosis of AF and increase adequate use of oral anticoagulation, especially in older and symptomatic patients with comorbidities.

Hybrid Decision Support to Monitor Atrial Fibrillation for Stroke Prevention

“…Initially, what constitutes a dangerous condition could follow Holter monitoring protocols. For example, an AF event is detected when the estimated AF probability is above 0.5 for at least 30 s [ 58 ]. However, it is not known if such an approach is sensitive and indeed specific enough to capture the stroke risk for patients.…”

Predictors of post-stroke cognitive impairment at three-month following first episode of stroke among patients attended at tertiary hospitals in Dodoma, central Tanzania: A protocol of a prospective longitudinal observational study metadata

“…A qualified cardiac physiologist analyses and reports the Holter study; however, the supervising cardiologist is ultimately responsible for the Holter analyses’ correct authorization. Atrial fibrillation is defined as chaotic atrial arrhythmia with loss of p wave activity and irregular RR interval lasting for at least 30 seconds [ 50 ]…”

An old diagnostic tool for new indications: inpatient Holter ECG for conditions other than syncope or stroke

“…We than reviewed all hospitalization progress notes and discharge summary of each patient to include patients based on our mentioned inclusion criteria. We selected and evaluated specific baseline characteristics based upon known risk factors for diagnostic Holter ECG monitoring from previous studies 12 , 13 . Hypertension, diabetes, and hyperlipidemia were included only if patients received a relevant treatment prior to admission.…”