What does this research mean for the field?

Automated analysis of continuous stroke unit ECG monitoring detects significantly more cases of paroxysmal atrial fibrillation in post-stroke patients compared to standard 24-hour Holter ECG. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To compare 24-hour Holter electrocardiography with continuous stroke unit ECG monitoring (CEM) and automated CEM analysis for the detection of paroxysmal atrial fibrillation after acute stroke or transient ischemic attack.

August 8, 2012Stroke

Continuous Stroke Unit Electrocardiographic Monitoring Versus 24-Hour Holter Electrocardiography for Detection of Paroxysmal Atrial Fibrillation After Stroke

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute ischemic stroke or transient ischemic attack (n=496). Intervention: Continuous stroke unit ECG monitoring (CEM) with automated analysis vs. 24-hour Holter electrocardiography. Primary outcome: Detection of paroxysmal atrial fibrillation (p=<0.001).

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Key result

Automated analysis of continuous stroke unit ECG monitoring detected significantly more cases of paroxysmal atrial fibrillation than 24-hour Holter ECG (92.7% vs 34.1% of total cases; P<0.001).

Why the study?

Does continuous stroke unit ECG monitoring improve the detection of paroxysmal atrial fibrillation compared to 24-hour Holter ECG in patients with acute ischemic stroke or TIA?

Population

496 patients with acute ischemic stroke or transient ischemic attack, median age 69 years, 61.5% male…

Comparison

Continuous stroke unit ECG monitoring and… vs 24-hour Holter ECG

Design

Cohort

Follow-up

Median stroke unit stay 88.8 hours

Authors

TRTimolaos RizosHeidelberg University JGJanina GüntnerGerman Cancer Research Center EJEkkehart JenetzkyWitten/Herdecke University

Discussion

Member takes

Implication

Supports extended ECG monitoring in stroke units; leaves open effects on outcomes and anticoagulation.

Key Points

To compare 24-hour Holter electrocardiography with continuous stroke unit ECG monitoring (CEM) and automated CEM analysis for the detection of paroxysmal atrial fibrillation after acute stroke or transient ischemic attack.
Prospectively enrolled N=496 patients (median age 69 years; 61.5% male; 80.4% ischemic stroke, 19.6% transient ischemic attack) without prior history of atrial fibrillation or atrial fibrillation on admission 12-lead ECG.
All patients underwent both 24-hour Holter ECG and continuous stroke unit ECG monitoring (median automated CEM analysis duration: 64.0 hours, IQR 43.0–89.8).
Paroxysmal atrial fibrillation was documented in 41 of 496 patients (8.3%).
Among the 41 patients with paroxysmal atrial fibrillation, detection rates were 34.1% with 24-hour Holter, 65.9% with CEM, and 92.7% with automated CEM analysis.
Both standard CEM and automated CEM detected significantly more patients with paroxysmal atrial fibrillation than 24-hour Holter (P<0.001), and automated CEM detected more patients than standard CEM (P<0.001).

Study Design

Type

Observational (n=496)

Structured PICO

Does continuous stroke unit ECG monitoring improve the detection of paroxysmal atrial fibrillation compared to 24-hour Holter ECG in patients with acute ischemic stroke or TIA?

Population

496 patients with acute ischemic stroke (80.4%) or transient ischemic attack (19.6%), median age 69 years, 61.5% male. Excluded: history of atrial fibrillation or atrial fibrillation on admission ECG.

Intervention

Continuous stroke unit ECG monitoring (CEM) and automated CEM analysis

Comparator

24-hour Holter ECG

Outcome

Detection of paroxysmal atrial fibrillation (pxAF)surrogate

Main Result

Absolute Event Rate: 92.7% vs 34.1%

p-value: p=<0.001

Automated analysis of continuous stroke unit ECG monitoring significantly improves the detection of paroxysmal atrial fibrillation compared to standard 24-hour Holter ECG in acute stroke patients.

Cite This Study

Rizos et al. (2012) conducted an observational in Acute ischemic stroke or transient ischemic attack (n=496). Continuous stroke unit ECG monitoring (CEM) with automated analysis vs. 24-hour Holter electrocardiography was evaluated on Detection of paroxysmal atrial fibrillation (p=<0.001). Automated analysis of continuous stroke unit ECG monitoring detected significantly more cases of paroxysmal atrial fibrillation than 24-hour Holter ECG (92.7% vs 34.1% of total cases; P<0.001).

synapsesocial.com/papers/6a193eba20fe4b8df388b95d https://doi.org/10.1161/strokeaha.112.654954

Topics

Atrial fibrillation Persistent AF management Anticoagulation in AF

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Continuous Stroke Unit Electrocardiographic Monitoring Versus 24-Hour Holter Electrocardiography for Detection of Paroxysmal Atrial Fibrillation After Stroke

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Topics

Continuous Stroke Unit Electrocardiographic Monitoring Versus 24-Hour Holter Electrocardiography for Detection of Paroxysmal Atrial Fibrillation After Stroke

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

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Topics

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