Usefulness of ambulatory 7-day ECG monitoring for the detection of atrial fibrillation and flutter after acute stroke and transient ischemic attack
Usefulness of ambulatory 7-day ECG monitoring for the detection of atrial fibrillation and flutter after acute stroke and transient ischemic attack
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DOI：
10.1161/01.str.0000131269.69502.d9
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发表时间：
2004-07-01
期刊：
影响因子：
8.3
通讯作者：
Sztajzel, R
中科院分区：
文献类型：
--
作者：
Jabaudon, D;Sztajzel, J;Sztajzel, R
背景和目的 - 尽管心房颤动是心源性卒中的最常见原因，但这种心律失常仍然未被充分诊断，因为它通常是无症状或间歇性的，因此可能无法通过标准 12 导联心电图甚至 24 小时心电图记录（动态心电图）检测到。在这项研究中，我们假设使用事件循环记录 (ELR) 设备进行 7 天动态心电图监测，可以检测急性中风或短暂性脑缺血发作 (TIA) 后隐匿性心房颤动和心房扑动 (AF)。 方法 - 使用标准心电图对入院神经内科的 149 名连续患有急性中风或 TIA 的患者进行系统性筛查，以发现栓塞性心律失常。在标准心电图上没有出现房颤的情况下，患者接受 24 小时心电图记录（动态心电图），随后对动态心电图正常的患者进行 7 天动态心电图监测（ELR）。先前记录的持续性房颤、原发性出血性中风或急性大血管夹层的患者不包括在研究中。结果 - 22 名患者检测到房颤。标准心电图在入院时发现 2.7% 的病例（4/149 名患者）发生房颤，在 5 天内发现 4.1% 的其余患者发生房颤（6/145）。 Holter 在标准心电图正常的患者中发现了 5% 的 AF（7/139 名患者），而 ELR 在标准心电图正常且动态心电图正常的患者中检测到了 5.7% 的 AF（5/88 名患者）。结论 - 急性卒中或 TIA 后，ELR 发现了 AF 患者，而标准心电图和动态心电图仍未检测到房颤。因此，每一位怀疑有心源性栓塞机制的患者都应考虑 ELR。
Background and Purpose - Although atrial fibrillation is the most frequent cause of cardioembolic stroke, this arrhythmia remains underdiagnosed, as it is often asymptomatic or intermittent and, thus, may not be detected on standard 12-lead ECG or even 24-hour ECG recording ( Holter). In this study, we hypothesized that 7-day ambulatory ECG monitoring using an event-loop recording (ELR) device would detect otherwise occult episodes atrial fibrillation and flutter (AF) after acute stroke or transient ischemic attack (TIA).Methods - One hundred forty-nine consecutive patients admitted to our neurology department with an acute stroke or TIA were systematically screened for emboligenic arrhythmias using standard ECG. In the absence of AF on standard ECG, patients underwent 24-hour ECG recording ( Holter), which was followed by a 7-day ambulatory ECG monitoring ( ELR) in patients with a normal Holter. Patients with previously documented persistent AF, with primary hemorrhagic stroke, or with acute large vessel dissection were not included in the study.Results - AF was detected in 22 patients. Standard ECG identified AF in 2.7% of the cases at admission (4/149 patients) and in 4.1% of remaining patients within 5 days (6/145). Holter disclosed AF in 5% of patients with a normal standard ECG (7/139 patients), whereas ELR detected AF in 5.7% of patients with a normal standard ECG and normal Holter (5/88 patients).Conclusions - Following acute stroke or TIA, ELR identified patients with AF, which remained undetected with standard ECG and with Holter. ELR should, therefore, be considered in every patient in whom a cardioembolic mechanism is suspected.