Key result
7-day Holter monitoring detected atrial fibrillation in 10% of cryptogenic stroke patients compared to 5.6% with 72-hour Holter, while 30-day intermittent ECG yielded no additional diagnostic value.
Why the study?
Silent AF is a common cause of cryptogenic ischemic stroke, but 12-lead ECG and 24 h Holter are not efficient to reveal an occult arrhythmic cause.
Does 7-day Holter monitoring or 30-day intermittent ECG recording improve the detection of atrial fibrillation and supraventricular tachycardia compared to 72-hour Holter in patients with cryptogenic stroke free from arrhythmia on 24-hour Holter?
Observational (n=72)
Does 7-day Holter monitoring or 30-day intermittent ECG recording improve the detection of atrial fibrillation and supraventricular tachycardia compared to 72-hour Holter in patients with cryptogenic stroke free from arrhythmia on 24-hour Holter?
7-day Holter monitoring significantly improves the detection of atrial fibrillation and supraventricular tachycardia in cryptogenic stroke patients compared to 72-hour monitoring, whereas 30-day intermittent patient-activated recording has low diagnostic yield.
May support extended Holter monitoring after cryptogenic stroke; leaves open optimal duration, strategy, and outcome impact.
Introduction According to recent studies, silent atrial fibrillation (AF) is a common cause of cryptogenic ischemic stroke (CIS). 12-lead electrocardiogram (ECG) and 24 h Holter are not efficient to reveal an occult arrhythmic cause of stroke. Objectives The aim of the study was to evaluate 72 h Holter, 7 day Holter monitoring, and intermittent single-lead ECG recording in patients with CIS to identify cases with the arrhythmic cause of stroke in patients with CIS in whom 24 h ECG Holter was free from arrhythmia. Methods 72 patients (aged 60 ± 9 years, 44 males) with CIS and no arrhythmic findings in 24 h Holter were enrolled. All patients had 7 day Holter monitoring and received handheld ECG recorder (CheckMe, Viatom) for ambulatory 30 ± 3 days ECG recording. AF, supraventricular tachycardia (SVT runs of ≥5 QRS), and other arrhythmias were assessed in the first 72 h of Holter recording, in 7 day-recording, and in handheld ECG strips. Results 72 h-recording revealed AF in four cases (5.6%) and SVT in 18 (25%) cases. 7 day Holter confirmed AF in seven patients (10%) and SVT in 27 patients (37.5%). There was no difference in regards to CHADS2VASc score between patients with SVT and non-arrhythmic group (3.6 ± 1.1 vs 3.4 ± 1.6; p = NS). Symptoms did not correlate with findings. Patient-activated handheld ECG recorders were used with good compliance. The mean number of recordings was 49 ± 30. Except for PACs, there was only one case of AF documented in 3,531 strips. Conclusions 7 day Holter performs better than 72 h and reveals supraventricular arrhythmias in every third and AF in 10% of CIS patients who were free from arrhythmia in 24 h ECG monitoring. 30 day intermittent ECG monitor does not yield diagnostic value in CIS.
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Kułach et al. (2020) conducted an observational in Cryptogenic ischemic stroke (n=72). 7-day Holter monitoring vs. 72-hour Holter monitoring was evaluated on Detection of atrial fibrillation. 7-day Holter monitoring detected atrial fibrillation in 10% of cryptogenic stroke patients compared to 5.6% with 72-hour Holter, while 30-day intermittent ECG yielded no additional diagnostic value.
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