7-day Holter monitoring detected covert atrial fibrillation in 6.8% (95% CI 4.1%-11.1%) of patients with recent ESUS, with BNP and atrial premature contractions serving as significant predictors.
Cohort (n=289)
Does 7-day Holter monitoring improve the detection of covert atrial fibrillation in patients with recent embolic stroke of undetermined source?
A 7-day chest strap Holter monitor detects covert atrial fibrillation in approximately 7% of patients with recent ESUS, with elevated BNP and frequent APCs serving as strong predictors for detection.
AIM: This study aimed to investigate the diagnostic yield of 7-day Holter monitoring for detecting covert atrial fibrillation (AF) in patients with recent embolic stroke of undetermined source (ESUS) and to identify the pre-entry screening biomarkers that had significant associations with later detection of AF (clinicaltrials.gov. NCT02801708). METHODS: A total of 206 patients who have recent ESUS without previously documented AF underwent Holter electrocardiography using a chest strap-style monitor. External validation of biomarkers predictive of AF was performed using 83 patients with ESUS who were implanted with insertable cardiac monitors. RESULTS: The 7-day Holter monitoring started at a median of 13 days after the onset of stroke. AF was detected in 14 patients, and three of these showed a single AF episode lasting ＜2 min. The median time delay to the first documented AF was 50 h. Each of serum brain natriuretic peptide ≥ 66.0 pg/mL (adjusted odds ratio 5.23), atrial premature contractions (APCs) ≥ 345 beats (3.80), and APC short runs ≥ 13 (5.74) on 24-h Holter prior to the 7-day Holter showed a significant association with detection of AF, independent of age and physiological findings in this derivation cohort, and all of these showed a significant association in the validation cohort (adjusted odds ratio 6.59, 7.87, and 6.16, respectively). CONCLUSIONS: In recent ESUS patients, the detection rate of AF using the 7-day Holter monitoring was 6.8% (95% CI 4.1%-11.1%). Brain natriuretic peptide, APC count, and APC short runs in the standard clinical workup seemed to be predictors of covert AF.
Miyazaki et al. (Fri,) conducted a cohort in Embolic stroke of undetermined source (ESUS) (n=289). 7-day Holter monitoring was evaluated on Detection of covert atrial fibrillation (AF) (95% CI 4.1%-11.1%). 7-day Holter monitoring detected covert atrial fibrillation in 6.8% (95% CI 4.1%-11.1%) of patients with recent ESUS, with BNP and atrial premature contractions serving as significant predictors.