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

Abstract

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.

Detection of Atrial Fibrillation Among Patients With Stroke Due to Large or Small Vessel Disease: A Meta‐Analysis

“…The search yielded 25 385 results (Figure ). The meta‐analysis included 30 studies comprising 5687 patients (study characteristics, Tables and ). All included studies were cohort studies.…”

“…Twenty‐one studies had a prospective design and the other 10 were retrospective studies with consecutive enrollment of stroke patients . Stroke etiology of included patients was not defined in 21 studies (4337 patients, Table ) . The 9 remaining studies categorized stroke patients according to stroke subtype (1350 patients with small or large vessel stroke, Table ) .…”

“…12,13,15,23,26,[31][32][33][34]38 Stroke etiology of included patients was not defined in 21 studies (4337 patients, Table 2). 6,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] The 9 remaining studies categorized stroke patients according to stroke subtype (1350 patients with small or large vessel stroke, Table 1). [12][13][14][15][16][17][18][19][20] Of those, 5 used the Trial of ORG 10172 in acute stroke treatment (TOAST) classification for allocation of stroke subtypes.…”

“…24,29 None of these studies specified the stroke etiology. The interval between admission of a patient and the start of monitoring was not always specified and differed greatly between individual studies, ranging from initiation at admission 33,39,40 to more than 2 to 3 weeks post stroke 21 (Tables 1 and 2). The definition of AF differed between studies (Tables 1 and 2).…”

Cryptogenic Stroke and Embolic Stroke of Undetermined Source: Risk Factors and Approaches for Detection of Atrial Fibrillation

“…Automated continuous electrocardiogram monitoring (aCEM) showed low sensitivity, especially in paroxysms of atrial fibrillation, and lack of specificity in the hourly risk assessment of AF [ 88 ].…”