Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
Department of Neurology, Medical University of Vienna, Vienna, Austria.
Eur J Neurol. 2023 Jul;30(7):2092-2098. doi: 10.1111/ene.15741. Epub 2023 Feb 24.
Previous studies investigating prolonged electrocardiogram (ECG)-monitoring after ischemic stroke had significant gaps between the index event and the beginning of long-term monitoring. Atrial fibrillation (AF) detection might be higher if prolonged cardiac rhythm documentation is performed with a gapless approach without any interruption of monitoring time.
This investigator-initiated, prospective study included patients with acute ischemic stroke or transient ischemic attack at three study centers. Participants received gapless ECG-monitoring via telemetry during stroke-unit admission until implantation of an insertable cardiac monitor (ICM) within the first days after the index event. Patients acted as their own controls and also received standard 24-72-h Holter ECG.
A total of 110 patients were included, of whom 86 (78.2%) had an embolic stroke of unknown source, 14 (12.7%) had small-vessel disease, and 10 (9.1%) had large-artery disease. AF was newly diagnosed in 17 (15.5%) patients via ICM monitoring, compared to one (0.9%) patient via Holter ECG during 6 months of follow-up (p < 0.001). The detection rate of AF within the first 30 days was 10.0%, which accounted for 64% of all new AF diagnoses. The median duration of the detected episodes was 1.7 (interquartile range = 0.2-4.7) h. All patients with new onset AF were treated with oral anticoagulation.
Gapless ECG-monitoring is an effective strategy to significantly increase the detection rate of AF after ischemic stroke. This finding supports the use of long-term ECG-monitoring with a gapless approach without any interruption in monitoring time as the gold standard for clinical practice.
既往研究表明，缺血性脑卒中后进行长时间心电图（ECG）监测时，起始事件与开始长期监测之间存在明显的时间间隔。如果采用无间隔的方法进行连续的心脏节律记录，而不中断监测时间，可能会提高对房颤（AF）的检出率。
这是一项由研究者发起的前瞻性研究，纳入了三个研究中心的急性缺血性脑卒中或短暂性脑缺血发作患者。参与者在卒中单元住院期间接受无间隔的遥测 ECG 监测，直至在起始事件发生后的最初几天内植入可植入式心脏监测仪（ICM）。患者自身作为对照，也接受标准的 24-72 小时动态心电图监测。
共纳入 110 例患者，其中 86 例（78.2%）为不明原因的栓塞性脑卒中，14 例（12.7%）为小血管疾病，10 例（9.1%）为大动脉疾病。通过 ICM 监测新诊断出 17 例（15.5%）患者的 AF，而通过 6 个月的随访期间的 Holter ECG 监测仅发现 1 例（0.9%）患者新诊断出 AF（p<0.001）。在最初的 30 天内，AF 的检出率为 10.0%，占所有新发 AF 诊断的 64%。检测到的 AF 发作持续时间中位数为 1.7 小时（四分位距=0.2-4.7）。所有新发 AF 的患者均接受了口服抗凝治疗。
无间隔的 ECG 监测是一种有效的策略，可显著提高缺血性脑卒中后 AF 的检出率。这一发现支持采用无间隔的方法进行长时间 ECG 监测，而不中断监测时间，作为临床实践的金标准。
