Al-Busaidi Salim, Al-Lawati Hatim, Al-Maqrashi Nasiba, Gujjar Arunodaya R
Internal Medicine Training Program, Oman Medical Specialty Board, Muscat, Oman.
Department of Medicine, Sultan Qaboos University Hospital, University Medical City, Muscat, Oman.
Sultan Qaboos Univ Med J. 2025 May 2;25(1):191-199. doi: 10.18295/2075-0528.2824.
This study aimed to assess the operating characteristics of standard 12-lead electrocardiogram (ECG) and 24-hour Holter studies in detecting atrial tachyarrhythmia in patients with acute stroke syndromes. The study's objective was to determine the potential factors that increased the likelihood of detecting atrial fibrillation (AF) and its impact on management.
This retrospective cohort study included adults (aged ≥18 years) admitted at Sultan Qaboos University Hospital from January 2010 to December 2019, with ischaemic stroke or transient ischaemic attack and had undergone a 24-hour Holter study. The hospital stroke registry was used to screen patients.
A total of 1,258 patients were screened and only 460 patients, who had undergone 521 Holter studies, met the inclusion criteria. Among them, AF was detected with baseline ECG in 20 patients (4.4%), while new AF was detected in only eight patients (1.7%). Significant predictors for increased AF detection by Holter included advanced age, peripheral vascular disease (PVD), left ventricular diastolic dysfunction and chronic kidney disease Stage III, with PVD highlighted as an independent predictor (odds ratio = 17.133, 95% confidence interval = 2.139-137.201, = 0.007). The degree of agreement between the baseline ECG and Holter ECG was substantial (K = 0.649, < 0.001). A total of 130 Holter needs to be performed to detect one case of treatable AF.
This study showed that a routine ECG Holter study in acute stroke has a low clinical yield in detecting AF, which is in substantial agreement with baseline ECG. Therefore, further investigation of paroxysmal AF in acute stroke should be reserved for high-risk patients.
本研究旨在评估标准12导联心电图（ECG）和24小时动态心电图监测在检测急性卒中综合征患者房性快速心律失常方面的操作特征。该研究的目的是确定增加检测心房颤动（AF）可能性的潜在因素及其对治疗的影响。
这项回顾性队列研究纳入了2010年1月至2019年12月在苏丹卡布斯大学医院住院的成年人（年龄≥18岁），这些患者患有缺血性卒中或短暂性脑缺血发作，并接受了24小时动态心电图监测。利用医院卒中登记册筛选患者。
共筛选出1258例患者，只有460例接受了521次动态心电图监测的患者符合纳入标准。其中，20例患者（4.4%）通过基线心电图检测到房颤，而仅8例患者（1.7%）检测到新发房颤。动态心电图检测房颤增加的显著预测因素包括高龄、外周血管疾病（PVD）、左心室舒张功能障碍和慢性肾脏病Ⅲ期，其中PVD被视为独立预测因素（比值比=17.133，95%置信区间=2.139-137.201，P=0.007）。基线心电图和动态心电图之间的一致性程度较高（K=0.649，P<0.001）。总共需要进行130次动态心电图监测才能检测到1例可治疗的房颤。
本研究表明，急性卒中患者进行常规心电图动态心电图监测检测房颤的临床检出率较低，这与基线心电图基本一致。因此，急性卒中阵发性房颤的进一步检查应仅针对高危患者。
