Key result
Early and prolonged 7-day Holter monitoring significantly increased the detection rate of paroxysmal atrial fibrillation compared to 24-hour monitoring (12.5% vs 4.8%, P=0.015).
Why the study?
Does early and prolonged (7 days) continuous Holter monitoring improve the detection of paroxysmal atrial fibrillation in patients with cerebral ischemia presenting in sinus rhythm compared to 24-hour monitoring?
Observational (n=281)
Does early and prolonged (7 days) continuous Holter monitoring improve the detection of paroxysmal atrial fibrillation in patients with cerebral ischemia presenting in sinus rhythm compared to 24-hour monitoring?
Absolute Event Rate: 12.5% vs 4.8%
p-value: p=0.015
Prolonged 7-day Holter monitoring significantly increases the detection of paroxysmal atrial fibrillation in patients with cerebral ischemia compared to standard 24-hour monitoring, leading to relevant changes in anticoagulation therapy.
Extended monitoring may identify more AF after stroke; leaves open effects on anticoagulation decisions and outcomes.
BACKGROUND AND PURPOSE: Diagnosis of paroxysmal atrial fibrillation is difficult but highly relevant in patients presenting with cerebral ischemia yet free from atrial fibrillation on admission. Early initiation and prolongation of continuous Holter monitoring may improve diagnostic yield compared with the standard of care including a 24-hour Holter recording. METHODS: In the observational Find-AF trial (ISRCTN 46104198), consecutive patients presenting with symptoms of cerebral ischemia were included. Patients free from atrial fibrillation at presentation received 7-day Holter monitoring. RESULTS: Two hundred eighty-one patients were prospectively included. Forty-four (15.7%) had atrial fibrillation documented by routine electrocardiogram on admission. All remaining patients received Holter monitors at a median of 5.5 hours after presentation. In those 224 patients who received Holter monitors but had no previously known paroxysmal atrial fibrillation, the detection rate with early and prolonged (7 days) Holter monitoring (12.5%) was significantly higher than for any 24-hour (mean of 7 intervals: 4.8%, P = 0.015) or any 48-hour monitoring interval (mean of 6 intervals: 6.4%, P = 0.023). Of those 28 patients with new atrial fibrillation on Holter monitoring, 15 (6.7%) had been discharged without therapeutic anticoagulation after routine clinical care (ie, with data from 24-hour Holter monitoring only). Detection rates were 43.8% or 6.3% for short supraventricular runs of ≥ 10 beats or prolonged episodes (> 5 hours) of atrial fibrillation, respectively. Diagnostic yield appeared to be only slightly and not significantly increased during the first 3 days after the index event. CONCLUSIONS: Prolongation of Holter monitoring in patients with symptoms of cerebral ischemic events increases the rate of detection of paroxysmal atrial fibrillation up to Day 7, leading to a relevant change in therapy in a substantial number of patients. Early initiation of monitoring does not appear to be crucial. Hence, prolonged Holter monitoring (≥ 7 days) should be considered for all patients with unexplained cerebral ischemia.
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Stahrenberg et al. (2010) conducted an observational in Cerebral ischemia presenting in sinus rhythm (n=281). Early and prolonged continuous Holter monitoring vs. 24-hour or 48-hour Holter monitoring was evaluated on Detection rate of paroxysmal atrial fibrillation (p=0.015). Early and prolonged 7-day Holter monitoring significantly increased the detection rate of paroxysmal atrial fibrillation compared to 24-hour monitoring (12.5% vs 4.8%, P=0.015).
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