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October 16, 2013Stroke

Improved Detection of Silent Atrial Fibrillation Using 72-Hour Holter ECG in Patients With Ischemic Stroke

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Key result

72-hour Holter ECG monitoring improved the detection of unknown atrial fibrillation in stroke or TIA survivors to 4.3% compared to 2.6% with 24-hour monitoring (number needed to screen 55).

Why the study?

Does 72-hour Holter ECG monitoring improve the detection of unknown atrial fibrillation in survivors of stroke or TIA compared to 24-hour monitoring?

Population

1,135 unselected survivors of a stroke or transient ischemic attack without known atrial fibrillation, mean…

Comparison

72-hour Holter ECG monitoring directly after… vs The first 24 hours of the same ECG monitoring.

Design

Cohort

Follow-up

72 hours

Authors

MGMartin GrondGHGerhard F. HamannESErwin Stark

Discussion

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Overview

Supports extended monitoring for post-stroke AF detection; leaves open whether it improves outcomes in randomized trials.

Key Points

  • To evaluate the diagnostic utility of systematic 72-hour Holter ECG monitoring for detecting previously unknown paroxysmal atrial fibrillation in patients presenting with acute ischemic stroke or TIA.
  • Conducted a prospective, multicenter cohort study across 9 stroke centers in Germany enrolling 1,135 unselected stroke or TIA survivors without prior atrial fibrillation between May 2010 and January 2011.
  • All patients underwent 72-hour Holter ECG monitoring immediately following admission in addition to standard diagnostic workup, with ECGs evaluated by 2 independent central observers to compare 24-hour and 72-hour detection rates.
  • Systematic 72-hour monitoring detected unknown atrial fibrillation in 49 of 1,135 patients (4.3%, 95% CI, 3.4–5.2%).
  • While 29 patients (2.6%) were diagnosed within the initial 24 hours of monitoring, prolonged recording identified 20 additional cases between 24 and 72 hours, yielding a number needed to screen of 55 patients (95% CI, 35–123) for each additional diagnosis.
  • Patients with detected atrial fibrillation were significantly older and more likely to have a history of stroke, with detections uniformly distributed across TOAST stroke pathogenesis categories.

Study Design

Type

Cohort (n=1,135)

Multicenter

Yes

Structured PICO

Does 72-hour Holter ECG monitoring improve the detection of unknown atrial fibrillation in survivors of stroke or TIA compared to 24-hour monitoring?

P
Population
1,135 unselected survivors of stroke or TIA without known atrial fibrillation (mean age 67 years, 45% women) underwent 72-hour Holter ECG monitoring.
E
Exposure
72-hour Holter ECG monitoring directly after admission.
C
Comparator
The first 24 hours of the same ECG monitoring.
O
Outcome
Proportion of previously undiagnosed (unknown) atrial fibrillation detected.surrogate

Main Result

Number Needed to Treat: 55 (95% CI 35–123)

Absolute Event Rate: 4.3% vs 2.6%

Number Needed to Treat: 55

Extending Holter ECG monitoring to 72 hours in patients with ischemic stroke or TIA significantly improves the detection of previously unknown paroxysmal atrial fibrillation compared to standard 24-hour monitoring.

Cite This Study

Grond et al. (2013) conducted a cohort in Ischemic stroke or transient ischemic attack (TIA) (n=1,135). 72-hour Holter ECG monitoring vs. 24-hour ECG monitoring was evaluated on Detection of unknown atrial fibrillation (NNS 55, 95% CI 35-123). 72-hour Holter ECG monitoring improved the detection of unknown atrial fibrillation in stroke or TIA survivors to 4.3% compared to 2.6% with 24-hour monitoring (number needed to screen 55).

synapsesocial.com/papers/6a86ff41ddd5671cb07cc64ahttps://doi.org/10.1161/strokeaha.113.001884
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