14-day Holter monitoring for atrial fibrillation after ischemic stroke : The yield of guideline-recommended monitoring duration
© European Stroke Organisation 2022..
Introduction: Current European Stroke Organisation (ESO) guidelines recommend >48 h of continuous electrocardiographic monitoring for atrial fibrillation (AF) in all patients with ischemic stroke or transient ischemic attack (TIA) with undetermined origin. We assessed the yield of the guideline-recommended monitoring for AF, as well as of extending monitoring up to 14 days.
Patients and methods: We included consecutive patients with stroke/TIA without AF in an academic hospital in The Netherlands. We reported AF incidence and number needed to screen (NNS) in the overall sample after 48 h and 14 days of Holter monitoring.
Results: Among 379 patients with median age 63 years (IQR 55-73), 58% male, Holter monitoring detected 10 cases of incident AF during a median of 13 (IQR 12-14) days of monitoring. Seven AF cases were detected within the first 48 hours (incidence 1.85%, 95% CI 0.74-3.81; NNS 54), and three additional AF cases were recorded among the 362 patients with >48 h of monitoring and without AF ⩽ 48 h (incidence 0.83%, 95% CI: 0.17-2.42; NNS 121). All AF cases were detected within the first 7 days of monitoring. Our sample was subject to sampling bias favoring inclusion of participants with low AF risk.
Discussion: Strengths of this work were the broad inclusion criteria as recommended by ESO guidelines, and high Holter adherence among participants. The analysis was limited by inclusion of lower-risk cases and a relatively small sample size.
Conclusion: In low-risk patients with recent stroke or TIA, ESO guideline-recommended screening for AF resulted in a low AF yield, with limited additional value of monitoring up to 14 days. Our results underline the need for a personalized approach in determining a patient's optimum duration for post-stroke non-invasive ambulatory monitoring.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:8 |
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| Enthalten in: |
European stroke journal - 8(2023), 1 vom: 03. März, Seite 157-167 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Himmelreich, Jelle Cl [VerfasserIn] |
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| Links: |
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| Themen: |
Atrial fibrillation |
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| Anmerkungen: |
Date Completed 17.07.2023 Date Revised 18.07.2023 published: Print-Electronic NTR: NTR6489 Citation Status MEDLINE |
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| doi: |
10.1177/23969873221146027 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM355258544 |
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| 245 | 1 | 0 | |a 14-day Holter monitoring for atrial fibrillation after ischemic stroke |b The yield of guideline-recommended monitoring duration |
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| 500 | |a Date Completed 17.07.2023 | ||
| 500 | |a Date Revised 18.07.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a NTR: NTR6489 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © European Stroke Organisation 2022. | ||
| 520 | |a Introduction: Current European Stroke Organisation (ESO) guidelines recommend >48 h of continuous electrocardiographic monitoring for atrial fibrillation (AF) in all patients with ischemic stroke or transient ischemic attack (TIA) with undetermined origin. We assessed the yield of the guideline-recommended monitoring for AF, as well as of extending monitoring up to 14 days | ||
| 520 | |a Patients and methods: We included consecutive patients with stroke/TIA without AF in an academic hospital in The Netherlands. We reported AF incidence and number needed to screen (NNS) in the overall sample after 48 h and 14 days of Holter monitoring | ||
| 520 | |a Results: Among 379 patients with median age 63 years (IQR 55-73), 58% male, Holter monitoring detected 10 cases of incident AF during a median of 13 (IQR 12-14) days of monitoring. Seven AF cases were detected within the first 48 hours (incidence 1.85%, 95% CI 0.74-3.81; NNS 54), and three additional AF cases were recorded among the 362 patients with >48 h of monitoring and without AF ⩽ 48 h (incidence 0.83%, 95% CI: 0.17-2.42; NNS 121). All AF cases were detected within the first 7 days of monitoring. Our sample was subject to sampling bias favoring inclusion of participants with low AF risk | ||
| 520 | |a Discussion: Strengths of this work were the broad inclusion criteria as recommended by ESO guidelines, and high Holter adherence among participants. The analysis was limited by inclusion of lower-risk cases and a relatively small sample size | ||
| 520 | |a Conclusion: In low-risk patients with recent stroke or TIA, ESO guideline-recommended screening for AF resulted in a low AF yield, with limited additional value of monitoring up to 14 days. Our results underline the need for a personalized approach in determining a patient's optimum duration for post-stroke non-invasive ambulatory monitoring | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Ischemic stroke | |
| 650 | 4 | |a TIA | |
| 650 | 4 | |a atrial fibrillation | |
| 650 | 4 | |a screening | |
| 700 | 1 | |a Lucassen, Wim Am |e verfasserin |4 aut | |
| 700 | 1 | |a Coutinho, Jonathan M |e verfasserin |4 aut | |
| 700 | 1 | |a Harskamp, Ralf E |e verfasserin |4 aut | |
| 700 | 1 | |a de Groot, Joris R |e verfasserin |4 aut | |
| 700 | 1 | |a Cpm van Weert, Henk |e verfasserin |4 aut | |
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