Holter monitoring detected paroxysmal atrial fibrillation in 9.2% of patients with stroke or TIA, with acute cortical infarcts strongly predicting its presence (OR 5.8; 95% CI 1.9-17.8).
Observational (n=426)
No
What are the prevalence and predictors of paroxysmal atrial fibrillation detected by Holter monitoring in patients with stroke or TIA?
Holter monitoring detects paroxysmal atrial fibrillation in nearly 10% of stroke/TIA patients, with acute or chronic brain infarcts on neuroimaging serving as strong predictors.
BACKGROUND AND PURPOSE: Our aims were to quantify the yield of Holter monitor for detection of paroxysmal atrial fibrillation (PAF) in patients with stroke and TIA, and to determine potential predictors of PAF to allow more focused testing. METHODS: We reviewed records of 1128 consecutive patients attending a university stroke clinic from September 2005 to September 2006 and identified 426 patients with definite TIA or stroke. We abstracted clinical, cardiac imaging, and neuroimaging data. Logistic regression analysis was performed to determine independent predictors of PAF on Holter monitor. RESULTS: Overall, 413 of 426 patients (65 ± 15 years; male, 49.8%) with a definite TIA (53%) or stroke (47%) underwent Holter monitoring for a mean of 22.6 hours. PAF occurred in 39 patients (9.2%) all older than age 55 years. PAF lasting > 30 seconds was evident in 11 patients (2.5%). The other 28 patients had PAF < 30 seconds (6.5%). In multivariate analyses, number of acute (odds ratio OR, 1.7 for each 1 lesion increase; 95% confidence interval CI, 1.2-2.6; P = 0.0047) and chronic (OR, 1.6 for each 1 lesion increase; 95% CI, 1.2-2.3; P = 0.0001) infarcts on brain CT, number of chronic infarcts on MRI (OR, 3.0 for each 1 lesion increase; 95% CI, 1.7-5.1; P < 0.0001), and any acute cortical infarct on imaging (OR, 5.8; 95% CI, 1.9-17.8; P = 0.0023) were associated with PAF. CONCLUSIONS: PAF is present in 9.2% of patients with definite stroke or TIA. Age older than 55 years and presence of acute or chronic brain infarcts on neuroimaging are strongly associated with PAF.
Alhadramy et al. (Fri,) conducted a observational in Stroke or Transient Ischemic Attack (n=426). Holter monitoring was evaluated on Detection of paroxysmal atrial fibrillation (PAF). Holter monitoring detected paroxysmal atrial fibrillation in 9.2% of patients with stroke or TIA, with acute cortical infarcts strongly predicting its presence (OR 5.8; 95% CI 1.9-17.8).