Diagnostic yield of chest and thumb ECG after cryptogenic stroke, Transient ECG Assessment in Stroke Evaluation (TEASE): an observational trial

Abstract

ObjectiveIn stroke survivors, atrial fibrillation (AF) is typically evaluated solely by short-term ECG monitoring in the stroke unit. Prolonged continuous ECG monitoring or insertable cardiac monitors require substantial resources. Chest and thumb ECG could provide an alternative means of AF detection, which in turn could allow prompt anticoagulation to prevent recurrent stroke. The objective of this study was to assess the yield of newly diagnosed AF during 28 days of chest and thumb ECG monitoring two times per day in cryptogenic stroke.MethodsThis study, Transient ECG Assessment in Stroke Evaluation, included patients who had a stroke from Region Gävleborg, Sweden, between 2017 and 2019. Patients with a recent ischaemic stroke without documented AF (or other reasons for anticoagulation) before or during ECG evaluation in the stroke unit were evaluated using the Coala Heart Monitor connected to a smartphone application for remote monitoring.ResultsThe prespecified number of 100 patients (mean age 67.6±10.8 years; 60% men) was analysed. In nine patients (9%, number needed to screen 11) AF but no other significant atrial arrhythmias (>30 s) was diagnosed. The mean CHA2DS2-VASc score was similar among patients with AF and no AF (4.9±1.1 vs 4.3±1.3; p=0.224) and patients with AF were older (74.3±9.0 vs 66.9±10.8; p=0.049). Patients performed on average 90.1%±15.0% of scheduled transmissions.ConclusionIn evaluation of cryptogenic stroke, 9% of patients had AF detected using chest and thumb ECG two times per day during 1 month. In many stroke survivors, this is a feasible approach and they will be potentially protected from recurrent stroke by anticoagulation treatment.Trial registration numberNCT03301662.

Smartphone App in Stroke Management: A Narrative Updated Review

“…There have been several studies demonstrating that smartwatches can detect AF events [ 74 ]. Devices such as belts [ 75 ], miniaturized electrocardiograms (ECGs) associated with smartphone Apps [ 8 , 76 ], and devices that are placed on the patient’s chest have also been used [ 77 , 78 ].…”

“…Moreover, the use of smartphone embedded sensors (gyroscope and accelerometer), along with ad-ditional wearable technologies, provides a constant monitoring of the rehabilitation phases quantifying and recording parameters such as walking, posture, and balance [50][51][52][53][54]81,82 and ensure continuous monitoring of vital parameters with the aim of a more comprehensive management of risk factors for stroke. [74][75][76][77][78] In addition, telemedicine-based technologies allow healthcare providers to remotely track patient's exercise and progress. 60 Teleconsultation, however, is not always possible due to technological and logistical limitations such as the presence of an effective Internet network and the 24-hour presence of an active consultant.…”

“…74 Devices such as belts, 75 miniaturized electrocardiograms (ECGs) associated with smartphone Apps, 8,76 and devices that are placed on the patient's chest have also been used. 77,78 Another useful App in the management of AF is AFib 2gether mobile App, 79,80 which was developed by Pfizer Inc. (New York, NY, USA). It is a helpful tool for sharing decision-making regarding anticoagulation therapy for AF.…”

A meta-analysis of extended ECG monitoring in detection of atrial fibrillation in patients with cryptogenic stroke

“…Of the 19 studies reporting on MCOTs, 13 studies (68.4%) reported on compliance 4 12 13 17 19–27. Compliance to using MCOTs was recorded as the percentage of the total ideal duration of monitoring.…”

“… 20 Despite this, studies examining handheld ECG monitoring devices have found that such devices have good compliance, 20 even better than chest belts once patients have mastered the handheld devices. 27 A majority of patients reported that twice daily monitoring of handheld devices over a 4-week period is feasible. 39 Nonetheless, some patients would be unable to handle the device because of cognitive or physical impairments.…”