Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Amsterdam Public Health, Personalized Medicine, Amsterdam, The Netherlands.
Eur Stroke J. 2023 Mar;8(1):157-167. doi: 10.1177/23969873221146027. Epub 2022 Dec 23.
Current European Stroke Organisation (ESO) guidelines recommend >48 h of continuous electrocardiographic monitoring for atrial fibrillation (AF) in all patients with ischemic stroke or transient ischemic attack (TIA) with undetermined origin. We assessed the yield of the guideline-recommended monitoring for AF, as well as of extending monitoring up to 14 days.
We included consecutive patients with stroke/TIA without AF in an academic hospital in The Netherlands. We reported AF incidence and number needed to screen (NNS) in the overall sample after 48 h and 14 days of Holter monitoring.
Among 379 patients with median age 63 years (IQR 55-73), 58% male, Holter monitoring detected 10 cases of incident AF during a median of 13 (IQR 12-14) days of monitoring. Seven AF cases were detected within the first 48 hours (incidence 1.85%, 95% CI 0.74-3.81; NNS 54), and three additional AF cases were recorded among the 362 patients with >48 h of monitoring and without AF ⩽ 48 h (incidence 0.83%, 95% CI: 0.17-2.42; NNS 121). All AF cases were detected within the first 7 days of monitoring. Our sample was subject to sampling bias favoring inclusion of participants with low AF risk.
Strengths of this work were the broad inclusion criteria as recommended by ESO guidelines, and high Holter adherence among participants. The analysis was limited by inclusion of lower-risk cases and a relatively small sample size.
In low-risk patients with recent stroke or TIA, ESO guideline-recommended screening for AF resulted in a low AF yield, with limited additional value of monitoring up to 14 days. Our results underline the need for a personalized approach in determining a patient's optimum duration for post-stroke non-invasive ambulatory monitoring.
目前，欧洲卒中组织（ESO）指南建议对所有不明原因的缺血性卒中和短暂性脑缺血发作（TIA）患者，进行 >48 小时的连续心电图监测，以筛查心房颤动（AF）。我们评估了指南推荐的监测 AF 的效果，以及将监测时间延长至 14 天的效果。
我们纳入了荷兰一家学术医院中连续的卒中/TIA 患者，且这些患者无 AF。我们报告了在进行 48 小时和 14 天动态心电图监测后，整体样本中 AF 的发生率和筛查所需人数（NNS）。
在 379 名中位年龄为 63 岁（IQR 55-73）、58%为男性的患者中，中位监测时间为 13（IQR 12-14）天，监测期间发现 10 例新发 AF。7 例 AF 病例在最初的 48 小时内被检出（发生率 1.85%，95%CI 0.74-3.81；NNS 54），而在 362 名 >48 小时且无 48 小时内 AF 的患者中，又检出 3 例 AF（发生率 0.83%，95%CI：0.17-2.42；NNS 121）。所有的 AF 病例均在监测的第 7 天内被检出。我们的样本存在选择偏倚，倾向于纳入 AF 风险较低的患者。
本研究的优势在于遵循了 ESO 指南广泛的纳入标准，以及患者对动态心电图监测的高度依从性。但本研究也存在一定的局限性，包括纳入的低风险病例和相对较小的样本量。
在近期发生卒中或 TIA 的低风险患者中，ESO 指南推荐的 AF 筛查方法检出率较低，监测时间延长至 14 天也仅有有限的额外价值。我们的结果强调了在确定患者进行卒中后非侵入性动态监测的最佳时间时，需要采取个体化的方法。
