Lyckhage Louise Feldborg, Hansen Morten Lock, Procida Kristina, Wienecke Troels
Department of Neurology, Zealand University Hospital, Roskilde, Denmark.
Department of Cardiology, The Cardiovascular Research Centre, Copenhagen University Hospital Herlev and Gentofte, Gentofte Denmark.
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105014. doi: 10.1016/j.jstrokecerebrovasdis.2020.105014. Epub 2020 Jun 27.
Early detection of atrial fibrillation (AF) after stroke is essential to achieve timely initiation of appropriate prophylactic treatment. We aimed to assess the diagnostic value of using prehospital continuous ECG (cECG) for AF detection after acute stroke.
In this retrospective cohort study, we included AF naïve ischemic stroke patients of 50 years or older. Medical records and corresponding digital prehospital cECGs were systematically reviewed. The proportion of AF detectable by prehospital cECG, in-hospital 12-lead ECG, telemetry and outpatient cECG was determined. McNemar's chi-squared test was used to compare probability of AF on prehospital cECG vs. in-hospital 12-lead ECG.
In 500 included patients, a new onset AF was detectable by prehospital cECG in 27 patients (5.4% [95% CI 3.6-7.8]). In-hospital 12-lead ECG detected AF in 28 of 458 patients (6.1% [95% CI 4.1-8.7). Sixty-two (12.4% [95% CI 9.6-15.6]) were diagnosed with new onset AF by either prehospital cECG, in-hospital 12-lead ECG, in-hospital telemetry or outpatient cECG. Thus, 43.5% of all AF cases were detectable during prehospital transport. The probability of AF did not differ between prehospital cECG and in-hospital 12-lead ECG. Nevertheless, a lack in overlapping diagnoses meant number needed to screening with prehospital cECG was 16 for diagnosing one AF case not detected by in-hospital 12-lead ECG.
Using prehospital cECG as an addition to very early AF evaluation after acute stroke had diagnostic value and could represent a low cost and easily accessible opportunity for very early AF detection. This may improve post-stroke care and save resources for further unnecessary AF screening. Conducting routine prehospital cECG after acute stroke and ensuring this is available to clinicians is encouraged.
卒中后早期检测房颤对于及时启动适当的预防性治疗至关重要。我们旨在评估院前连续心电图（cECG）对急性卒中后房颤检测的诊断价值。
在这项回顾性队列研究中，我们纳入了50岁及以上既往无房颤的缺血性卒中患者。系统回顾了病历和相应的数字化院前cECG。确定了院前cECG、院内12导联心电图、遥测和门诊cECG可检测到的房颤比例。采用McNemar卡方检验比较院前cECG与院内12导联心电图检测到房颤的概率。
在纳入的500例患者中，27例（5.4%[95%CI 3.6 - 7.8]）患者院前cECG可检测到新发房颤。458例患者中有28例（6.1%[95%CI 4.1 - 8.7]）院内12导联心电图检测到房颤。62例（12.4%[95%CI 9.6 - 15.6]）通过院前cECG、院内12导联心电图、院内遥测或门诊cECG诊断为新发房颤。因此，所有房颤病例中有43.5%在院前转运期间可被检测到。院前cECG与院内12导联心电图检测到房颤的概率无差异。然而，由于缺乏重叠诊断，对于每一例未被院内12导联心电图检测到的房颤病例，院前cECG筛查所需的例数为16例。
急性卒中后将院前cECG作为早期房颤评估的补充具有诊断价值，且可能是一种低成本且易于获取的早期房颤检测机会。这可能改善卒中后护理并节省进一步不必要房颤筛查的资源。鼓励在急性卒中后进行常规院前cECG检查并确保临床医生能够获取。
