Department of Cardiovascular Medicine, Division of Electrophysiology, University Hospital of Muenster, Muenster, Germany.
Department of Neurology, University Hospital of Muenster, Muenster, Germany.
Eur J Neurol. 2018 Apr;25(4):631-636. doi: 10.1111/ene.13538. Epub 2018 Feb 13.
Detection of occult atrial fibrillation (AF) is crucial for optimal secondary prevention in stroke patients. The AF detection rate was determined by implantable cardiac monitor (ICM) and compared to the prediction rate of the probability of incident AF by software based analysis of a continuously monitored electrocardiogram at follow-up (stroke risk analysis, SRA); an optimized AF detection algorithm is proposed by combining both tools.
In a monocentric prospective study 105 out of 389 patients with cryptogenic stroke despite extensive diagnostic workup were investigated with two additional cardiac monitoring tools: (a) 20 months' monitoring by ICM and (b) SRA during hospitalization at the stroke unit.
The detection rate of occult AF was 18% by ICM (n = 19) (range 6-575 days) and 62% (n = 65) had an increased risk for AF predicted by SRA. When comparing the predictive accuracy of SRA to ICM, the sensitivity was 95%, specificity 35%, positive predictive value 27% and negative predictive value 96%. In 18 patients with AF detected by ICM, SRA also showed a medium risk for AF. Only one patient with a very low risk predicted by SRA developed AF revealed by ICM after 417 days.
A combination of SRA and ICM is a promising strategy to detect occult AF. SRA is reliable in predicting incident AF with a high negative predictive value. Thus, SRA may serve as a cost-effective pre-selection tool identifying patients at risk for AF who may benefit from further cardiac monitoring by ICM.
检测隐匿性心房颤动（AF）对中风患者的最佳二级预防至关重要。通过植入式心脏监测器（ICM）确定 AF 的检测率，并与基于软件的连续监测心电图在随访时（中风风险分析，SRA）对事件性 AF 概率的预测率进行比较；通过结合这两种工具提出了一种优化的 AF 检测算法。
在一项单中心前瞻性研究中，对 389 例隐匿性中风患者中的 105 例进行了两项额外的心脏监测工具检查：（a）通过 ICM 进行 20 个月的监测，（b）在中风单元住院期间进行 SRA。
ICM 检测隐匿性 AF 的检出率为 18%（n = 19）（范围 6-575 天），SRA 预测 62%（n = 65）有发生 AF 的风险增加。当比较 SRA 对 ICM 的预测准确性时，敏感性为 95%，特异性为 35%，阳性预测值为 27%，阴性预测值为 96%。在 18 例通过 ICM 检测到 AF 的患者中，SRA 也显示出中等的 AF 风险。只有 1 例 SRA 预测为极低风险的患者在 417 天后通过 ICM 显示出 AF。
SRA 和 ICM 的组合是检测隐匿性 AF 的一种有前途的策略。SRA 在预测事件性 AF 方面具有较高的阴性预测值，是可靠的。因此，SRA 可能作为一种具有成本效益的筛选工具，识别出有 AF 风险的患者，这些患者可能受益于进一步的 ICM 心脏监测。
