Key result
Automated ST/AR telemetry linked to ~2-fold higher detection of AF vs. routine stroke unit care.
Why the study?
The rate of newly detected atrial fibrillation during inpatient cardiac telemetry is low, prompting evaluation of an automated detection algorithm compared with routine detection by a stroke unit team.
Does an automated detection algorithm improve the diagnostic yield of atrial fibrillation compared to routine analysis in patients with recent ischemic stroke or TIA?
Observational (n=507)
Single-blind
No
Does an automated detection algorithm improve the diagnostic yield of atrial fibrillation compared to routine analysis in patients with recent ischemic stroke or TIA?
An automated AF detection algorithm during 24-hour telemetry in stroke patients increases the detection rate of paroxysmal AF compared to routine analysis alone, though false positives require careful evaluation.
May increase AF detection on telemetry in stroke patients; leaves open need for validation before practice change.
BACKGROUND AND PURPOSE: The rate of newly detected (paroxysmal) atrial fibrillation (AF) during inpatient cardiac telemetry is low. The objective of this study was to evaluate the additional diagnostic yield of an automated detection algorithm for AF on telemetric monitoring compared with routine detection by a stroke unit team in patients with recent ischemic stroke or TIA. METHODS: Patients admitted to the stroke unit of Medisch Spectrum Twente with acute ischemic stroke or TIA and no history of AF were prospectively included. All patients had telemetry monitoring, routinely assessed by the stroke unit team. The ST segment and arrhythmia monitoring (ST/AR) algorithm was active, with deactivated AF alarms. After 24 h the detections were analyzed and compared with routine evaluation. RESULTS: Five hundred and seven patients were included (52.5% male, mean age 70.2 ± 12.9 years). Median monitor duration was 24 (interquartile range 22-27) h. In 6 patients (1.2%) routine analysis by the stroke unit team concluded AF. In 24 patients (4.7%), the ST/AR Algorithm suggested AF. Interrater reliability was low (κ, 0.388, p < 0.001). Suggested AF by the algorithm turned out to be false positive in 11 patients. In 13 patients (2.6%) AF was correctly diagnosed by the algorithm. None of the cases detected by routine analysis were missed by the algorithm. CONCLUSIONS: Automated AF detection during 24-h telemetry in ischemic stroke patients is of additional value to detect paroxysmal AF compared with routine analysis by the stroke unit team alone. Automated detections need to be carefully evaluated.
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Maten et al. (2020) conducted an observational in Acute ischemic stroke or TIA (n=507). Automated ST/AR algorithm for AF detection vs. Routine stroke unit team analysis was evaluated on Newly detected atrial fibrillation (κ = 0.388, 95% CI 0.169-0.608, p=<0.001). The automated ST/AR algorithm correctly diagnosed atrial fibrillation in 2.6% of patients during 24-hour telemetry, compared to 1.2% detected by routine stroke unit team analysis alone.
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