Abstract 21500: Enhanced Detection of Paroxysmal Atrial Fibrillation by Early and Prolonged Continuous Holter Monitoring in Patients With Cerebral Ischemia Presenting in Sinus Rhythm
Background and Purpose: Diagnosis of paroxysmal atrial fibrillation is difficult, but highly relevant in patients presenting with cerebral ischemia yet free from atrial fibrillation on admission. Early initiation and prolongation of continuous Holter monitoring may improve diagnostic yield compared to standard of care including a 24 h Holter recording.
Methods: In the observational Find-AF trial (ISRCTN 46104198), consecutive patients presenting with symptoms of cerebral ischemia were included. Patients free from atrial fibrillation at presentation received 7 day Holter monitoring
Results: 281 patients were prospectively included. 44 (15.7 %) had atrial fibrillation documented by routine ECG on admission. All remaining patients received Holter monitors at a median of 5.5 h after presentation. In patients without previously known paroxysmal atrial fibrillation, the detection rate with early and prolonged (7 d) Holter monitoring (12.5 %) was significantly higher than for any 24 h (4.8 %, p = 0.015) or any 48 h monitoring interval (6.4 %, p = 0.023). Of those 28 patients with new atrial fibrillation on Holter monitoring, 15 (6.7 %) had been discharged without therapeutic anticoagulation after routine clinical care. Detection rates were 43.8 % or 6.3 % for short supraventricular runs of ≥ 10 beats or prolonged episodes (> 5 h) of atrial fibrillation, respectively. Diagnostic yield appeared to be only slightly and not significantly increased during the first three days following the index event.
Conclusions: Prolongation of Holter monitoring in patients with symptoms of cerebral ischemic events increases the rate of detection of paroxysmal atrial fibrillation up to day seven, leading to a relevant change in therapy in a substantial number of patients. Early initiation of monitoring does not appear to be crucial. Hence, prolonged Holter monitoring (≥ 7 d) should be considered for all patients with unexplained cerebral ischemia.
- © 2010 by American Heart Association, Inc.