Screening of Paroxysmal Atrial Fibrillation after Ischemic Stroke: 48-Hour Holter Monitoring versus Prolonged Intermittent ECG Recording

Orrsjö, Gustav; Cederin, Björn; Bertholds, Eric; Nasic, Salmir; Welin, Lennart

doi:10.1155/2014/208195

Cited by 8 publications

(7 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a single-centre retrospective analysis, 13 out of 114 patients (11.4%) with stroke/TIA had AF detected by a Zenicor ECG during a 21-day follow-up with recordings scheduled two times per day. 34 Episodes of less than 30 s were not considered as AF. Notably, the mean age of the patients was 70.3 years and 27.2% had a diagnosis of TIA.…”

Section: Discussionmentioning

confidence: 99%

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

2020

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

2020

View full text Add to dashboard Cite

show abstract

“…In this pragmatic trial, five patients were non-compliant due to misunderstanding, five were unable to complete the screening due to technical problems and three for other causes. 24 …”

Section: Discussionmentioning

confidence: 99%

“…In this pragmatic trial, five patients were non-compliant due to misunderstanding, five were unable to complete the screening due to technical problems and three for other causes. 24 A retrospective analysis of Zion-patch applications in patients who had a stroke/TIA showed high compliance (98.7%) during a median wearing time of 13.0 days. 25 Handheld ECG in screening The thumb ECG has been used in screening programmes in several settings.…”

Section: Handheld Ecg After Strokementioning

confidence: 99%

Patient-reported feasibility of chest and thumb ECG after cryptogenic stroke in Sweden: an observational study

2020

View full text Add to dashboard Cite

ObjectivesThe aim of this study was to assess the feasibility, based on a questionnaire, of the chest and thumb ECG system Coala Heart Monitor in patients who recently had a stroke.DesignObservational study.SettingTwo stroke units, Region Gävleborg, Sweden.Participants and interventionsThis study, Transient ECG Assessment in Stroke Evaluation (TEASE), included patients who had a stroke between 2017 and 2019. Patients eligible for anticoagulation in the presence of atrial fibrillation were scheduled for 28 days monitoring.Primary and secondary outcome measuresThe questionnaire regarding feasibility of monitoring included seven questions, using a 100 mm Visual Analogue Scale which covered overall satisfaction, technical feasibility, remember to monitor, physical application, feeling of security, help from others and recommendation to others. A lower score indicated better outcome.ResultsThe prespecified number of 100 patients underwent the monitoring and 83 out of the 97 alive patients returned the questionnaire (response rate 85.6%). The median age was 69.5 years, mean CHA2DS2-VASc score was 4.4±1.3 points and 59.0% were men (n=49). The median time from index stroke to start of monitoring was 7.0 days. Patients performed on average 90.1%±15.0% of scheduled ECG-transmissions. In all seven questions, the median score ranged from 4 to 8. The vast majority reported acceptable outcomes, that is, the 95th percentile ranged from 30 to 54. There was no significant difference between men and women with regard to any of the seven questions (p values ranging from 0.117 to 0.849). Two of the seven outcome scores correlated significantly to patient age (Spearman’s r=−0.238 and r=−0.308, and p values 0.031 and 0.005 for ‘overall satisfaction’ and ‘remember to monitor’, respectively).ConclusionIn stroke survivors, chest and thumb ECG two times per day over a period of 4 weeks is feasible from a patient’s perspective. The Coala Heart Monitor provides a valuable and convenient tool for monitoring after stroke.Trial registration numberNCT03301662.

show abstract

“…For example, AF was detected in 11.4% of post-stroke patients monitored by thumb ECG over 21 days versus 2.8% in those continuously monitored for 48 hours. 23 …”

Section: Introductionmentioning

confidence: 99%

A protocol for a prospective observational study using chest and thumb ECG: transient ECG assessment in stroke evaluation (TEASE) in Sweden

2018

View full text Add to dashboard Cite

IntroductionAtrial fibrillation (AF) causes ischaemic stroke and based on risk factor evaluation warrants anticoagulation therapy. In stroke survivors, AF is typically detected with short-term ECG monitoring in the stroke unit. Prolonged continuous ECG monitoring requires substantial resources while insertable cardiac monitors are invasive and costly. Chest and thumb ECG could provide an alternative for AF detection poststroke.The primary objective of our study is to assess the incidence of newly diagnosed AF during 28 days of chest and thumb ECG monitoring in cryptogenic stroke. Secondary objectives are to assess health-related quality of life (HRQoL) using short-form health survey (SF-36) and the feasibility of the Coala Heart Monitor in patients who had a stroke.MethodsStroke survivors in Region Gävleborg, Sweden, will be eligible for the study from October 2017. Patients with a history of ischaemic stroke without documented AF before or during ECG evaluation in the stroke unit will be evaluated by the chest and thumb ECG system Coala Heart Monitor. The monitoring system is connected to a smartphone application which allows for remote monitoring and prompt advice on clinical management. Over a period of 28 days, patients will be monitored two times a day and may activate the ECG recording at symptoms. On completion, the system is returned by mail. This system offers a possibility to evaluate the presence of AF poststroke, but the feasibility of this system in patients who recently suffered from a stroke is unknown. In addition, HRQoL using SF-36 in comparison to Swedish population norms will be assessed. The feasibility of the Coala Heart Monitor will be assessed by a self-developed questionnaire.Ethics and disseminationThe study was approved by The Regional Ethical Committee in Uppsala (2017/321). The database will be closed after the last follow-up, followed by statistical analyses, interpretation of results and dissemination to a scientific journal.Trial registration numberNCT03301662; Pre-results.

show abstract

Screening of Paroxysmal Atrial Fibrillation after Ischemic Stroke: 48-Hour Holter Monitoring versus Prolonged Intermittent ECG Recording

Cited by 8 publications

References 23 publications

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

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

Patient-reported feasibility of chest and thumb ECG after cryptogenic stroke in Sweden: an observational study

A protocol for a prospective observational study using chest and thumb ECG: transient ECG assessment in stroke evaluation (TEASE) in Sweden

Contact Info

Product

Resources

About