Continuous stroke unit electrocardiographic monitoring versus 24-hour Holter electrocardiography for detection of paroxysmal atrial fibrillation after stroke
Abstract
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 with acute ischemic stroke or transient ischemic attack were prospectively enrolled. After a 12-channel ECG on admission, all patients received 24-hour Holter ECG and CEM. Additionally, ECG monitoring data underwent automated analysis using dedicated software to identify pxAF. Patients with a history of atrial fibrillation or with atrial fibrillation on the admission ECG were excluded. RESULTS: Four hundred ninety-six patients (median age, 69 years; 61.5% male) fulfilled all inclusion criteria (ischemic stroke: 80.4%; transient ischemic attack: 19.6%). Median stroke unit stay lasted 88.8 hours (interquartile range, 65.0-122.0). ECG data for automated CEM analysis were available for a median time of 64.0 hours (43.0-89.8). Paroxysmal AF was documented in 41 of 496 patients (8.3%). Of these, Holter detected pxAF in 34.1%; CEM in 65.9%; and automated CEM in 92.7%. CEM and automated CEM detected significantly more patients with pxAF than Holter (P<0.001), and automated CEM detected more patients than CEM (P<0.001). CONCLUSIONS: Automated analysis of CEM improves pxAF detection in patients with stroke on stroke units compared with 24-hour Holter ECG. The comparative usefulness of prolonged or repetitive Holter ECG recordings requires further evaluation.
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There is good evidence that prolonged ECG monitoring enhances the detection of undiagnosed AF, for 72 hours after a stroke, for even longer periods, or by daily short-term ECG recording in patients over 75 years of age.
“There is good evidence that prolonged ECG monitoring enhances the detection of undiagnosed AF, for 72 hours after a stroke, 27,127 for even longer periods, 18,128 or by daily short-term ECG recording in patients over 75 years of age 129 (Web Addenda Figure 1).”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [127]
Several studies have also found AF in patients in whom another competing cause for stroke has been identified clinically.
“Several studies have also found AF in patients in whom another competing cause for stroke has been identified clinically (e.g.hypertension or carotid artery stenosis).27,127”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [127]
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- Authors
- Rizos, T., Güntner, J., Jenetzky, E., Marquardt, L., Reichardt, C., Becker, R., Reinhardt, R., Hepp, T., Kirchhof, P., Aleynichenko, E., Ringleb, P., Hacke, W., & Veltkamp, R.
- Affiliations
- German Cancer Research Center (DE)
- Venue
- Stroke
- Published
- 2012-10
- Volume
- 43
- Issue
- 10
- Pages
- 2689-2694
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2110678376
- Cited by
- 218
- References
- 33
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 12 · 2023: 9 · 2022: 12 · 2021: 12 · 2020: 12 · 2019: 13 · 2018: 22 · 2017: 25 · 2016: 22 · 2015: 23 · 2014: 24 · 2013: 17 · 2012: 4
- FWCI
- 13.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
- Keywords
- paroxysmal atrial fibrillation, ischemic stroke, transient ischemic attack, stroke unit, continuous ECG monitoring, Holter monitoring, cardiac embolism, secondary stroke prevention, automated ECG analysis
- MeSH terms
- Aged, Atrial Fibrillation, Ischemic Attack, Transient, Hospital Units, Humans, Inpatients, Male, Middle Aged, Monitoring, Physiologic, Outpatients, Prospective Studies, Risk Factors, Time Factors, Electrocardiography, Ambulatory, Stroke, Secondary Prevention
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