Cannizzaro F, Izquierdo A, Cocho D
Family Medicine Department, Hospital General de Granollers, Barcelona, Spain.
Neurology Department, Hospital General de Granollers, Barcelona, Spain.
Front Neurol. 2024 Apr 29;15:1353812. doi: 10.3389/fneur.2024.1353812. eCollection 2024.
Holter-SRA (Stroke Risk Analysis) is an automated analysis of ECG monitoring for Atrial Fibrillation (AF) detection. The aim of this study was to evaluate the rate of AF in undetermined TIA/Rapidly improving stroke symptoms (RISS) patients.
Prospective study of undetermined TIA/RISS patients who presented to the emergency department. Early vascular studies (angio CT, transthoracic echocardiography and ECG) were performed in emergency department. The Holter-SRA device was placed for 2 h and the patients were classified into: confirmed AF, high risk of AF or low risk of AF. Prolonged ambulatory monitoring (7 days) was carried out every month for patients with a high-risk pattern. The results were evaluated until definitive detection of AF or low-risk pattern. The endpoints were rate of AF and vascular recurrence at 90 days.
Over a period of 24 months, 83 undetermined TIA/RISS patients were enrolled. The mean age was 70 ± 10 years and 61% were men. The median ABCD score was 4 points (1-7). After 2 h of monitoring in the emergency department, AF was detected in one patient (1.2%), 51 patients with a low-risk pattern and 31 patients (37.3%) showed a high-risk pattern of AF. During the ambulatory monitoring, of the 31 patients high risk pattern patients, AF was diagnosed to 17 cases and of the 51 patients with a low-risk pattern, one case experienced a recurrent vascular due to undetected AF (1.9% false negative). Three patients (3.6%) suffered a vascular recurrence within the first 90 days, before AF diagnosis.
In our study, AF was detected in 22.9% of the 83 patients with indeterminate TIA/RISS. Holter-SRA has allowed us to increase the detection of AF, especially those patients with a high-risk pattern in the first 3 months.
动态心电图卒中风险分析（Holter-SRA）是一种用于检测心房颤动（AF）的心电图监测自动分析方法。本研究的目的是评估不明原因短暂性脑缺血发作/快速改善型卒中症状（TIA/RISS）患者的房颤发生率。
对就诊于急诊科的不明原因TIA/RISS患者进行前瞻性研究。在急诊科进行早期血管检查（血管CT、经胸超声心动图和心电图）。放置Holter-SRA设备2小时，患者被分为：确诊房颤、房颤高危或房颤低危。对高危模式患者每月进行7天的延长动态监测。评估结果直至明确检测到房颤或低危模式。终点指标为90天时的房颤发生率和血管复发率。
在24个月的时间里，纳入了83例不明原因TIA/RISS患者。平均年龄为70±10岁，61%为男性。ABCD评分中位数为4分（1-7分）。在急诊科监测2小时后，1例患者（1.2%）检测到房颤，51例患者为低危模式，31例患者（37.3%）显示房颤高危模式。在动态监测期间，31例高危模式患者中，17例被诊断为房颤，51例低危模式患者中，1例因未检测到房颤而发生血管复发（假阴性率1.9%）。3例患者（3.6%）在房颤诊断前的前90天内发生了血管复发。
在我们的研究中，83例不明原因TIA/RISS患者中有22.9%检测到房颤。Holter-SRA使我们能够增加房颤的检测，特别是在最初3个月内具有高危模式的患者。
