Department of Neurology, Medisch Spectrum Twente, PO Box 50.000 7500 KA Enschede, the Netherlands; Health Technology and Services Research, Faculty of Behavioural Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands.
Department of Neurology, Admiraal de Ruyter Ziekenhuis, Goes, the Netherlands.
J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104930. doi: 10.1016/j.jstrokecerebrovasdis.2020.104930. Epub 2020 Jun 3.
The rate of newly detected (paroxysmal) atrial fibrillation (AF) during inpatient cardiac telemetry is low. The objective of this study was to evaluate the additional diagnostic yield of an automated detection algorithm for AF on telemetric monitoring compared with routine detection by a stroke unit team in patients with recent ischemic stroke or TIA.
Patients admitted to the stroke unit of Medisch Spectrum Twente with acute ischemic stroke or TIA and no history of AF were prospectively included. All patients had telemetry monitoring, routinely assessed by the stroke unit team. The ST segment and arrhythmia monitoring (ST/AR) algorithm was active, with deactivated AF alarms. After 24 h the detections were analyzed and compared with routine evaluation.
Five hundred and seven patients were included (52.5% male, mean age 70.2 ± 12.9 years). Median monitor duration was 24 (interquartile range 22-27) h. In 6 patients (1.2%) routine analysis by the stroke unit team concluded AF. In 24 patients (4.7%), the ST/AR Algorithm suggested AF. Interrater reliability was low (κ, 0.388, p < 0.001). Suggested AF by the algorithm turned out to be false positive in 11 patients. In 13 patients (2.6%) AF was correctly diagnosed by the algorithm. None of the cases detected by routine analysis were missed by the algorithm.
Automated AF detection during 24-h telemetry in ischemic stroke patients is of additional value to detect paroxysmal AF compared with routine analysis by the stroke unit team alone. Automated detections need to be carefully evaluated.
住院期间心脏遥测的新发（阵发性）心房颤动（AF）率较低。本研究的目的是评估与卒中单元团队常规检测相比，自动检测算法在近期缺血性卒中和 TIA 患者遥测监测中对 AF 的额外诊断价值。
前瞻性纳入急性缺血性卒中和 TIA 且无 AF 病史的患者入住 Medisch Spectrum Twente 卒中单元。所有患者均接受遥测监测，由卒中单元团队常规评估。ST 段和心律失常监测（ST/AR）算法处于活动状态，AF 警报被停用。24 小时后分析检测结果并与常规评估进行比较。
共纳入 507 例患者（52.5%为男性，平均年龄 70.2 ± 12.9 岁）。中位监测时间为 24 小时（四分位距 22-27 小时）。在 6 例患者（1.2%）中，卒中单元团队的常规分析提示 AF。在 24 例患者（4.7%）中，ST/AR 算法提示 AF。观察者间可靠性较低（κ，0.388，p < 0.001）。算法提示的 AF 中有 11 例为假阳性。在 13 例患者（2.6%）中，算法正确诊断出 AF。常规分析检测到的病例均未被算法遗漏。
与卒中单元团队单独进行常规分析相比，在缺血性卒中患者 24 小时遥测期间自动检测 AF 可额外发现阵发性 AF。需要对自动检测进行仔细评估。
