Key result
Supraventricular runs on post-stroke Holter monitoring linked to ~11.6-fold higher 3-year AF incidence.
Why the study?
Does the presence of supraventricular runs on baseline 7-day Holter monitoring predict a higher incidence of atrial fibrillation over a 3-year follow-up in cryptogenic ischemic stroke patients with a negative 24-hour Holter?
Cohort (n=78)
Does the presence of supraventricular runs on baseline 7-day Holter monitoring predict a higher incidence of atrial fibrillation over a 3-year follow-up in cryptogenic ischemic stroke patients with a negative 24-hour Holter?
Baseline 7-day Holter monitoring after cryptogenic stroke identifies supraventricular runs in over a third of patients with negative 24-hour Holters, which strongly predicts subsequent atrial fibrillation (RR 11.6) and helps select candidates for extended continuous ECG monitoring.
Answers are grounded in this paper and cite their sources.
Supraventricular runs may flag higher AF risk after cryptogenic stroke; leaves open whether targeted monitoring improves outcomes.
Introduction: Silent atrial fibrillation (AF) is a common cause of cryptogenic ischemic stroke (CIS). The 24-h-Holter is insufficient to reveal an occult arrhythmic cause of stroke and the strategy to select the patients for long-term monitoring is missing. Objectives: The aim of the study was to evaluate 7-day-Holter monitoring to identify cases with the arrhythmic cause of stroke in CIS patients in whom 24-h-Holter was free from arrhythmia, and to assess the relation between supraventricular (SV) runs in baseline Holter and the incidence of AF in a 3-year follow-up period. Methods: 78 patients (aged 60 ± 9 years, 45 males) with CIS and no arrhythmic findings in 24-h-Holter were enrolled. All patients had 7-day-Holter monitoring after stroke and were followed up for 36 months, and then 7-day Holter was repeated. We assessed SV runs (≥5 QRS) in the initial 7-day Holter and analyzed the relation of the findings with clinical characteristics of novel AF episodes revealed early after stroke and during a 3-year follow-up. Results: Baseline 7-day-Holter revealed SV runs in 36% of patients and AF in 9% of cases. During a 3-year follow-up, 8 additional cases were confirmed, both in standard care and in repeated Holter (a total of 19% of AF cases). There was no difference with regard to CHADS2VASc score (3.6 ± 1.1 vs. 3.4 ± 1.5; p = NS) and left atrium parameters between patients with SV runs and the non-arrhythmic group. Patients with SV runs had a higher incidence of AF both after stroke and in a 3-year follow-up (46% vs. 4%, RR 11.6, p < 0.001). In 8 cases, patent foramen ovale was detected during follow-up. Conclusions: A strategy of baseline 7-day-Holter monitoring after stroke allows for disclosing SV runs in every third case and AF in 9% of stroke survivors. Patients with SV runs have a higher incidence of AF (RR 11.6, p < 0.001) and should be considered for extended continuous ECG monitoring.
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Kułach et al. (2021) conducted a cohort in Cryptogenic ischemic stroke (n=78). Supraventricular runs (>=5 QRS, <30 s duration) on baseline 7-day Holter monitoring vs. No supraventricular runs on baseline 7-day Holter monitoring was evaluated on Incidence of atrial fibrillation (>30 s) early after stroke and during 3-year follow-up (RR 11.6, p=<0.001). Supraventricular runs on baseline 7-day Holter monitoring were associated with a higher 3-year incidence of atrial fibrillation compared to no runs.
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