Functional outcome in stroke patients with atrial fibrillation

Karataş, Metin; Dilek, Ayşe; Erkan, Hilal; Yavuz, Nur; Sözay, Seyhan; Akman, N

doi:10.1053/apmr.2000.6981

Cited by 38 publications

(37 citation statements)

References 28 publications

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“…The prevalence of AF increases with age; therefore, the contribution of AF to the overall stroke burden is expected to rise considerably because of ongoing demographic changes in our society [4,5]. Moreover, strokes due to AF are associated with greater disability and mortality [6,7,8,9]. Importantly, effective measures for stroke prevention in AF have been established [1,2,10,11,12,13,14].…”

Section: Introductionmentioning

confidence: 99%

Detection of Paroxysmal Atrial Fibrillation in Acute Stroke Patients

et al. 2010

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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 prospectively 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.

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Section: Introductionmentioning

confidence: 99%

Detection of Paroxysmal Atrial Fibrillation in Acute Stroke Patients

et al. 2010

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“…1 Atrial fibrillation (AF) causes at least 20% of all ischemic strokes; these strokes have a higher mortality and are frequently more disabling compared to other etiologies. [2][3][4] Ischemic strokes caused by AF can be effectively prevented by oral anticoagulation. 5,6 However, because AF is often asymptomatic [7][8][9] and only paroxysmally present, it can easily escape diagnosis ("silent AF" 10,11 ).…”

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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

182

137

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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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“…[1][2][3][4][5][6] Once identified, introduction of oral anticoagulant therapy (eg, warfarin; international normalized ratio 2 to 3) provides an additional 40% risk reduction in recurrent stroke compared with antiplatelet therapy. [7][8][9][10] Furthermore, recent evidence suggests that therapeutic oral anticoagulation (international normalized ratio 2 to 3) may also be associated with reduced stroke severity, if ischemic stroke does occur in patients with AF.…”

mentioning

confidence: 99%

“…11,12 Given that ischemic stroke with AF is associated with greater disability and mortality than those without AF, establishing the presence of underlying AF is of clear clinical importance. 3,[13][14][15] In addition to baseline electrocardiogram and clinical examination, noninvasive cardiac monitoring is used to detect AF. 16 -19 A previous review on this topic reported that 24-to 48-hour Holter monitoring identified AF in 1% to 5% of patients undetected by initial electrocardiogram.…”

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confidence: 99%

Noninvasive Cardiac Monitoring for Detecting Paroxysmal Atrial Fibrillation or Flutter After Acute Ischemic Stroke

Liao

Khalid

Scallan

et al. 2007

Stroke

306

185

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Background and Purpose-Identifying paroxysmal atrial fibrillation/flutter is an essential part of the etiological workup of patients with ischemic stroke. However, there is controversy in the literature regarding the use of noninvasive cardiac rhythm monitoring with previous reviews reporting a low detection rate with routine monitoring. We performed a systematic review to determine the frequency of occult atrial fibrillation/flutter detected by noninvasive methods of continuous cardiac monitoring after acute ischemic stroke or transient ischemic attack. Methods-Studies were identified from comprehensive searches of PubMed, EMBASE, Science Citation Index, and bibliographies of relevant articles. Only English language articles were included. Randomized controlled trials and prospective cohort studies of consecutive patients with acute ischemic stroke that fulfilled predefined criteria were eligible. Two authors conducted searches and abstracted data from eligible studies independently. Results-Sixty studies were deemed potentially eligible. After application of eligibility criteria, 5 studies (736 participants) were included in the analysis. All studies evaluated Holter monitoring; 2 also evaluated event loop recording. In studies that evaluated Holter monitoring (588 participants), new atrial fibrillation/flutter was detected in 4.6% (95% CI: 0% to 12.7%) of consecutive patients with ischemic stroke. Duration of monitoring ranged from 24 to 72 hours. Two studies (140 participants) evaluated event loop recorders after Holter monitoring. New atrial fibrillation/flutter was detected in 5.7% and 7.7% of consecutive patients in these 2 studies. Conclusions-Screening consecutive patients with ischemic stroke with routine Holter monitoring will identify new atrial fibrillation/flutter in approximately one in 20 patients. Although based on limited data, extended duration of monitoring may improve the detection rate. Further research is required before definitive recommendations can be made. (Stroke.

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Functional outcome in stroke patients with atrial fibrillation

Cited by 38 publications

References 28 publications

Detection of Paroxysmal Atrial Fibrillation in Acute Stroke Patients

Detection of Paroxysmal Atrial Fibrillation in Acute Stroke Patients

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

Noninvasive Cardiac Monitoring for Detecting Paroxysmal Atrial Fibrillation or Flutter After Acute Ischemic Stroke

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