Paroxysmal atrial fibrillation detection in patients with acute ischemic stroke through prolonged Holter: prospective study

Alves, Mariana; Narciso, Marco; Cruz, João; Rocha, Marina Veloso; Fonseca, Teresa

doi:10.1007/s40520-018-1014-x

Cited by 6 publications

(4 citation statements)

References 15 publications

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“…In 2009, Suissa et al (4) found that STAF score could be used to preliminarily screen for AF among patients with ischemic stroke, and the sensitivity and specificity values of STAF scores ≥5 for AF prediction were 89% and 88%, respectively. Later studies confirmed its effectiveness (5,13); however, many other studies have revealed poor effectiveness (6,7,14). Other scoring systems such as the LADS score and MrWALLETS score have been used to screen for AF, but their credibility and clinical values are less effective than STAF score.…”

Section: Discussionmentioning

confidence: 99%

Role of the score for the targeting of atrial fibrillation (STAF) combined with D-dimer in screening ischemic stroke patients with atrial fibrillation

Liu¹,

Xie²,

Zhu³

et al. 2024

J Med Biochemistry

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Background: We aim to explore the effect of the score for the targeting of atrial fibrillation (STAF) combined with the serum D-dimer (DD) level in screening acute ischemic stroke patients with atrial fibrillation (AF). Methods: This study is a retrospective case observation study. This study consecutively selected patients with acute ischemic stroke who were hospitalized in the Department of Neurology at Zhuhai Hospital Affiliated with Jinan University from February 2019 to February 2021. Venous blood was drawn from all patients within 24 hours of hospitalization for DD detection. In accordance with the medical records, the patients were classified into an AF group and a non-AF group and were scored according to the STAF standard. A combined test method was used to estimate the diagnostic screening value of the STAF combined with the DD value for acute ischemic stroke patients with AF. Results: A total of 480 patients were enrolled, of whom 73 patients (15.2%) had AF and 42 patients had paroxysmal AF. The diagnostic sensitivity of a STAF ≥ 5 for patients with AF was 78%, and the specificity was 91%. The diagnostic sensitivity of DD ≥ 826.5 ng/mL for AF was 70%, and the specificity was 76%. The diagnostic sensitivity of the two indicators combined for AF was 86%, and the specificity was 97%. Conclusion: The STAF combined with the serum DD level has good diagnostic value in screening acute ischemic stroke patients with AF.

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Section: Discussionmentioning

confidence: 99%

Role of the score for the targeting of atrial fibrillation (STAF) combined with D-dimer in screening ischemic stroke patients with atrial fibrillation

Liu¹,

Xie²,

Zhu³

et al. 2024

J Med Biochemistry

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“…Among patients treated for atrial fibrillation, 72‐h single‐lead ECG monitoring was superior to 24‐h Holter monitoring; an additional 13.6% of patients with negative results in Holter monitoring were diagnosed with paroxysmal atrial fibrillation using 72‐h single‐lead ECG monitoring 16 . Undiagnosed paroxysmal atrial fibrillation can lead to recurrent stroke or embolic events 17,18 . In addition, a higher atrial burden is a significant risk factor for clinical atrial fibrillation and future stroke 19 .…”

Section: Discussionmentioning

confidence: 99%

“… 16 Undiagnosed paroxysmal atrial fibrillation can lead to recurrent stroke or embolic events. 17 , 18 In addition, a higher atrial burden is a significant risk factor for clinical atrial fibrillation and future stroke. 19 In this regard, continuous monitoring using patch‐type ECG can be useful, especially for patients with a history of strokes or transient ischemic attacks.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of detecting arrhythmia is higher with 7‐day continuous electrocardiographic patch monitoring than with 24‐h Holter monitoring

Kim

Oh²,

Lee

et al. 2023

Journal of Arrhythmia

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Background: Detecting high-risk arrhythmia is important in diagnosing patients with palpitations. We compared the diagnostic accuracies of 7-day patch-type electrocardiographic (ECG) monitoring and 24-h Holter monitoring for detecting significant arrhythmias in patients with palpitations. Methods:This was a single-center prospective trial with 58 participants who presented with palpitations, chest pain or syncope. Outcomes were defined as the detection of any one of six arrhythmias, including supraventricular tachycardia (SVT), atrial fibrillation or atrial flutter lasting more than 30 s, pauses of more than 3 s, high-degree atrioventricular block, ventricular tachycardia (VT) >3 beats, or polymorphic VT/ventricular fibrillation. The McNemar test for paired proportions was used to compare arrhythmia detection rates. Results:The overall arrhythmia detection rate was higher with 7-day ECG patch monitoring than with 24-h Holter monitoring (34.5% vs. 19.0%, p = .008). Compared with the use of 24-h Holter monitors, the use of 7-day ECG patch monitors was associated with higher detection of SVT (29.3% vs. 13.8%, p = .042). No serious adverse skin reactions were reported among the ECG patch-monitored participants. Conclusions:The results suggest that a 7-day patch-type continuous ECG monitor is more effective for the detection of supraventricular tachycardia than is a 24-h Holter monitor. However, the clinical significance of device detected arrhythmia should be consolidated.

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“…Most of the standard diagnostic procedures have low sensitivity for pAF detection [ 7 ]. Extended durations of ECG recording, sometimes up to several weeks, may be necessary for detection of some episodes [ 8 , 9 ], but these resources are not widely available. Therefore, there are many attempts to identify novel and easy-to-test biomarkers for pAF [ 10 ].…”

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confidence: 99%

Seeking predictors for paroxysmal atrial fibrillation in stroke with an online clinical database

Erdener¹

2019

North Clin Istanbul

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OBJECTIVE: A considerable fraction of ischemic stroke cases remain cryptogenic and there is increasing data suggesting the role of missed paroxysmal atrial fibrillations (pAF) in at least a number of these cases. Since electrophysiological identification of pAFs can be challenging, there has been an accumulation of proposed predictors and biomarkers for pAFs. The predictive values of these is varying and sometimes conflicting among studies. Therefore, we aimed to verify a fraction of previously reported parameters for pAF detection by investigating an independent clinical sample. METHODS: Using a publicly available data downloaded from the MIMIC-3 intensive care unit database, we tested the predictive role of particular risk factors and biomarkers for pAF detection after ischemic stroke in 124 patients with ischemic stroke admitted within 24 hours of stroke onset. RESULTS: Our evaluation revealed a strong association of older age in women, as well as admission National Institutes of Health Stroke Scale (NIHSS) and discharge modified Rankin Scores (mRS) in both sexes for pAFs, in patients that were in sinus rhythm on admission. We also detected a trend for lower gender-adjusted hemoglobin in patients with pAF, although the difference was insignificant. On the other hand, we did not find any significant association of pAF detection with some other previously reported biomarkers: serum magnesium level, leukocyte count, neutrophil/lymphocyte ratio or left atrial dilatation. CONCLUSION: Even though our analysis did not reveal a strong and specific biomarker to predict pAFs after stroke, it identified key risk factors. It may be necessary to consider the possibility of pAFs and perform rigorous evaluation to prevent further events of embolic stroke in female patients older than 75 years, with more severe neurological deficits on admission, higher disability on discharge and also with relatively lower hemoglobin level. This first study from Turkey using clinical data from the MIMIC-3 database also demonstrates the value of publicized clinical data for confirmatory studies on various medical fields across the World.

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Paroxysmal atrial fibrillation detection in patients with acute ischemic stroke through prolonged Holter: prospective study

Abstract: In elderly patients with AIS, the use of an extended Holter recorder led to the detection of more cases of PAF, offering them the chance to initiate hypocoagulant therapy. Among this population, the STAF score was non-discriminative and did not prove useful in predicting PAF.

Cited by 6 publications

References 15 publications

Role of the score for the targeting of atrial fibrillation (STAF) combined with D-dimer in screening ischemic stroke patients with atrial fibrillation

Role of the score for the targeting of atrial fibrillation (STAF) combined with D-dimer in screening ischemic stroke patients with atrial fibrillation

The efficacy of detecting arrhythmia is higher with 7‐day continuous electrocardiographic patch monitoring than with 24‐h Holter monitoring

Seeking predictors for paroxysmal atrial fibrillation in stroke with an online clinical database

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