Department of Neurology, University Medical Center Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany.
Stroke. 2012 Apr;43(4):994-9. doi: 10.1161/STROKEAHA.111.642199. Epub 2012 Feb 2.
Anticoagulation is a highly effective secondary prevention in patients with cardioembolic stroke and atrial fibrillation/flutter (AF). However, the condition remains underdiagnosed, because paroxysmal AF may be missed by diagnostic tests in the acute phase. In this study, the sensitivity of AF detection was assessed for serial electrocardiographic recordings and continuous stroke unit telemetric monitoring with or without a structured algorithm to analyze telemetric data (SEA-AF).
Three hundred forty-six consecutive patients with acute ischemic stroke were prospectively included and subjected to standard telemetric monitoring. In addition, telemetric data were separately analyzed following SEA-AF, consisting of a structured evaluation of episodes with high risk for AF and a chronological beat-to-beat screening of the full registration. Serial electrocardiograms were conducted in 24-hour intervals.
Median effective telemetry monitoring time was 75.5 hours (interquartile range 64-86 hours). Overall, AF was diagnosed in 119 of 346 patients (34.4%). The structured reading algorithm was the most sensitive method to detected AF. Conventional telemetry and serial electrocardiographic assessments were less effective. However, only 35% of patients with previously documented paroxysmal AF and negative baseline electrocardiogram demonstrated AF episodes during monitoring.
Continuous stroke unit telemetry using SEA-AF shows a significantly higher detection rate for AF compared with daily electrocardiographic assessments and standard telemetry without structured reading. The low overall probability to detect paroxysmal AF with either method during the first days after stroke demonstrates the urgent need for complementary diagnostic strategies such as long-term monitoring and frequent follow-up assessments. Clinical Trial Registration- URL: www.clinicaltrials.gov. Unique identifier: NCT01177748.
抗凝治疗是心源性栓塞性卒中伴心房颤动/扑动（AF）患者的一种非常有效的二级预防措施。然而，由于阵发性 AF 可能在急性期的诊断性检查中漏诊，因此该疾病的诊断率仍然较低。在本研究中，评估了连续心电图记录和带有或不带有结构化算法的连续卒中单元遥测监测对 AF 检测的敏感性，以分析遥测数据（SEA-AF）。
前瞻性纳入 346 例连续急性缺血性卒中患者，并进行标准遥测监测。此外，分别按照 SEA-AF 对遥测数据进行分析，SEA-AF 包括对 AF 高危发作进行结构化评估以及对整个记录进行逐拍的时间顺序筛查。连续心电图在 24 小时间隔内进行。
中位有效遥测监测时间为 75.5 小时（四分位距 64-86 小时）。总体而言，346 例患者中有 119 例（34.4%）诊断为 AF。结构化阅读算法是检测 AF 最敏感的方法。常规遥测和连续心电图评估效果较差。然而，只有 35%的有先前记录的阵发性 AF 和阴性基线心电图的患者在监测期间出现 AF 发作。
使用 SEA-AF 的连续卒中单元遥测与每日心电图评估和无结构化阅读的标准遥测相比，对 AF 的检测率显著提高。两种方法在卒中后最初几天检测阵发性 AF 的总体概率均较低，这迫切需要补充诊断策略，如长期监测和频繁随访评估。临床试验注册- 网址：www.clinicaltrials.gov。独特标识符：NCT01177748。
