Knecht Stefan, Petsch Sebastian, Kirchhof Paulus, Studer Bettina
Mauritius Hospital, Strümper Straße 111, 40670 Meerbusch, Germany.
Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
Neurol Res Pract. 2019 Dec 20;1:41. doi: 10.1186/s42466-019-0046-9. eCollection 2019.
Many stroke survivors suffer recurrent stroke because paroxysmal atrial fibrillation (AF) was missed and no preventive anticoagulation initiated. This prospective cohort study determined the added diagnostic yield of second-look 24-h electrocardiographic recording (ECG) in a population at high risk for AF: patients who suffered a stroke of such severity that they require inpatient neurorehabilitation.
We enrolled 508 patients with ischemic stroke admitted to post-acute inpatient neurorehabilitation and determined whether AF was detected during acute care at the referring hospital. Second-look baseline and 24-h Holter ECG were then conducted during neurorehabilitation. Primary outcome was number of newly detected AF with duration of > 30 s; secondary outcomes were number of newly detected absolute arrhythmia of 10-30 s and < 10 s duration. For comparison, we further enrolled 100 patients with hemorrhagic stroke without history of AF (age = 72 + 11 years, 51% female).
In 206 of the 508 ischemic stroke patients, AF had been detected during acute phase work-up (age = 78 + 10 years, 55% female). For the remaining 302 ischemic stroke patients, no AF was detected during acute phase work-up (age = 74 + 9 years; 47% female). Second-look 24-h ECG showed previously missed AF of > 30 s in 20 of these patients, i.e. 6.6% of the sample, and shorter absolute arrhythmia in 50 patients (i.e. 16.5%).
Second-look 24-Hour ECG performed during post-acute inpatient neurorehabilitation has a high diagnostic yield and should become a standard component of recurrent stroke prevention.
许多中风幸存者会再次中风，因为阵发性心房颤动（AF）被漏诊且未启动预防性抗凝治疗。这项前瞻性队列研究确定了在AF高危人群中进行二次24小时心电图记录（ECG）的额外诊断价值：这些患者中风严重到需要住院神经康复治疗。
我们纳入了508例入住急性后期住院神经康复科的缺血性中风患者，并确定在转诊医院的急性治疗期间是否检测到AF。然后在神经康复期间进行二次基线和24小时动态心电图检查。主要结局是新检测到的持续时间>30秒的AF数量；次要结局是新检测到的持续时间为10 - 30秒和<10秒的绝对心律失常数量。为了进行比较，我们进一步纳入了100例无AF病史的出血性中风患者（年龄=72 + 11岁，51%为女性）。
在508例缺血性中风患者中，206例在急性期检查时检测到AF（年龄=78 + 10岁，55%为女性）。对于其余302例缺血性中风患者，急性期检查时未检测到AF（年龄=74 + 9岁；47%为女性）。二次24小时心电图显示，这些患者中有20例之前漏诊的持续时间>30秒的AF，即样本的6.6%，另有50例患者有较短的绝对心律失常（即16.5%）。
在急性后期住院神经康复期间进行的二次24小时心电图检查具有较高的诊断价值，应成为预防复发性中风的标准组成部分。
