Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Danderyd University Hospital and Karolinska Institutet, Stockholm, Sweden.
Ups J Med Sci. 2022 May 5;127. doi: 10.48101/ujms.v127.8318. eCollection 2022.
The detection of paroxysmal atrial fibrillation (AF) is of importance in stroke care. The method used is continuous electrocardiogram (ECG)-monitoring or multiple short ECG-recordings during an extended period. Their relative efficiency is a matter of discussion. In a retrospective cohort study on 994 patients with an ischemic stroke or transient ischemic attack (TIA), we have compared continuous 7-day monitoring to intermittent recording 60 sec three times daily with a handheld device during 3 weeks. We related the result to subsequent occurrence of AF as detected in 12-lead ECG recordings.
The patients were identified in the local database of cardiovascular investigations. Their clinical profile and vital status during the follow-up were obtained from the Swedish Stroke Register and the Swedish general population registry. For comparison, we used an age- and sex-matched population with no known cerebrovascular event and a population with a cerebrovascular event that was not screened.
AF was detected in 7.1% by continuous screening and in 5.1% by intermittent screening ( = 0.3). During follow-up of 32 months, AF in 12-lead ECG was found in 7.0%. In the subgroup with positive screening, 46.3% had AF compared with 6.7% in the subgroup with negative screening ( < 0.0001).
The two screening approaches had a similar yield of arrhythmia, in spite of the group with intermittent monitoring having a more favorable clinical profile. A positive screening was highly predictive of AF in ECG during the follow-up.
阵发性心房颤动（AF）的检测对中风护理很重要。目前使用的方法是连续心电图（ECG）监测或在延长时间内多次进行短时间 ECG 记录。它们的相对效率是一个讨论的问题。在一项针对 994 例缺血性卒中和短暂性脑缺血发作（TIA）患者的回顾性队列研究中，我们比较了连续 7 天监测与使用手持式设备在 3 周内每天 3 次记录 60 秒的间歇性记录。我们将结果与后续在 12 导联心电图记录中检测到的 AF 发生情况相关联。
患者在心血管检查的本地数据库中被识别。他们在随访期间的临床特征和生存状态从瑞典卒中登记处和瑞典一般人群登记处获得。为了进行比较，我们使用了年龄和性别匹配的没有已知脑血管事件的人群和没有进行筛查的有脑血管事件的人群。
连续筛查发现 AF 的比例为 7.1%，间歇性筛查发现 AF 的比例为 5.1%（=0.3）。在 32 个月的随访期间，在 12 导联心电图中发现 AF 的比例为 7.0%。在阳性筛查亚组中，46.3%有 AF，而在阴性筛查亚组中，这一比例为 6.7%（<0.0001）。
尽管间歇性监测组的临床特征更有利，但两种筛查方法的心律失常检出率相似。阳性筛查对后续心电图中的 AF 具有高度预测性。
