Abstract 10878: Improving Screening for Silent Atrial Fibrillation After Ischemic Stroke
Introduction: Anticoagulant treatment after an ischemic stroke/transient ischemic attack (TIA) is indicated in the presence of atrial fibrillation (AF). It is believed that silent paroxysmal AF is present in ischemic stroke patients to a larger extent than what is known.
Hypothesis: We hypothesized that by using intermittent ECG recordings in an ischemic stroke/TIA population more cases of AF would be diagnosed in comparison to continuous ECG recordings.
Method: 239 consecutive patients who had suffered an ischemic stroke/TIA and without known AF underwent a 24 hour continuous ECG recording and also performed 10 second rhythm recordings using a hand held ECG recorder twice daily for 30 days. The handheld ECG was transmitted to an Internet site by telephone. The two methods were compared to evaluate which method diagnosed the most AF cases. In addition, patients underwent a carotid artery duplex investigation and in most cases echocardiographic investigations.
Results: Out of 239 patients included 56 % were men, median age 72 years (39- 91). In total 17 patients were diagnosed with AF with both methods combined. Out of these, 12 AF diagnoses were made using intermittent ECG recordings only versus 2 AF diagnoses with 24 hour continuous ECG recordings. In three cases AF diagnosis was set with both methods. The percentage of AF diagnoses for the whole population was 7.1 % and increased to 11.7 % when including only patient's ≥ 75 years. Mean age for the AF patients was 75. 4 years (66- 84). Median number of AF episodes detected was 5 (1–23). No patients <65 years had AF. A significant difference in favour of the handheld ECG was shown between the two methods (P = 0,001).
Conclusions: Prolonged intermittent arrhythmia screening in patients who have suffered an ischemic stroke/TIA seems to be an efficient method to detect silent paroxysmal AF. This study indicates that this type of screening might be especially useful in patients over 65 years of age with a previous ischemic stroke. This method of screening may thus facilitate a more effective anticoagulant treatment in stroke patients with silent AF at increased risk of renewed stroke.
- © 2010 by American Heart Association, Inc.