Wachter Rolf, Weber-Krüger Mark, Hamann Gerhard F, Kermer Pawel, Liman Jan, Mende Meinhard, Seegers Joachim, Wasser Katrin, Gröschel Sonja, Uphaus Timo, Poppert Holger, Köhrmann Martin, Zabel Markus, Laufs Ulrich, Heuschmann Peter U, Conen David, Gröschel Klaus
Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany.
DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
J Stroke. 2022 Jan;24(1):98-107. doi: 10.5853/jos.2021.01207. Epub 2021 Dec 17.
Prolonged electrocardiography (ECG)-monitoring in stroke patients improves the detection of paroxysmal atrial fibrillation (pAF). However, most randomized studies only had short follow-up. We aimed to provide 3-year follow-up data for AF detection and stroke recurrence risk.
We randomized 402 patients aged ≥60 years with acute ischemic strokes without AF to either enhanced and prolonged monitoring (EPM; 3×10-day Holter-ECG-monitoring) or standard-of-care (≥24 hours ECG-monitoring). The endpoint of the current analysis was AF within 36 months analyzed by intention to treat. Long-term follow-up was performed for 36 months.
Two hundred and seventy-four patients (80%) participated in the extended follow-up (median duration of follow-up was 36 months [interquartile range, 12 to 36]). During the first 6 months, more AF was documented in the EPM arm compared to the control arm (13.5% vs. 5.1%; 95% confidence interval, 2.9% to 14.4%; P=0.004). During months 6 to 36, AF was less detected in the EPM intervention arm than in the control arm (2.0% vs. 7.3%; 95% confidence interval, 0.7% to 9.9%; P=0.028). Overall, the detection rate of AF within 36 months was numerically higher within the EPM group (15.0% vs. 11.1%, P=0.30). Numerically less patients in the EPM arm had recurrent ischemic strokes (5.5% vs. 9.1%, P=0.18), transient ischemic attacks (3.0% vs. 4.5%, P=0.44) or died (4.5% vs. 6.6%, P=0.37).
Enhanced and prolonged ECG monitoring increased AF detection during the first six months, but there was significantly more clinical AF during months 6 to 36 observed in the usual-care arm. This suggests that EPM leads to an earlier detection of clinically relevant AF.
对卒中患者进行长时间心电图（ECG）监测可提高阵发性心房颤动（pAF）的检出率。然而，大多数随机研究的随访时间较短。我们旨在提供房颤检测和卒中复发风险的3年随访数据。
我们将402例年龄≥60岁、急性缺血性卒中且无房颤的患者随机分为强化延长监测组（EPM；3次为期10天的动态心电图监测）或标准治疗组（≥24小时心电图监测）。本次分析的终点是按意向性分析在36个月内发生的房颤。进行了36个月的长期随访。
274例患者（80%）参与了延长随访（随访中位时间为36个月[四分位间距，12至36个月]）。在最初6个月内，EPM组记录到的房颤比对照组更多（13.5%对5.1%；95%置信区间，2.9%至14.4%；P=0.004）。在第6至36个月期间，EPM干预组检测到的房颤少于对照组（2.0%对7.3%；95%置信区间，0.7%至9.9%；P=0.028）。总体而言，EPM组36个月内房颤的检出率在数值上更高（15.0%对11.1%，P=0.30）。EPM组发生缺血性卒中复发（5.5%对9.1%，P=0.18）、短暂性脑缺血发作（3.0%对4.5%，P=0.44）或死亡（4.5%对6.6%，P=0.37）的患者在数值上更少。
强化延长心电图监测在最初6个月增加了房颤检测，但在6至36个月期间，常规治疗组观察到的临床房颤明显更多。这表明EPM可导致更早检测到临床相关房颤。
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