Occult Atrial Fibrillation in Cryptogenic Stroke Detection by 7-Day Electrocardiogram Versus Implantable Cardiac Monitors
Occult Atrial Fibrillation in Cryptogenic Stroke Detection by 7-Day Electrocardiogram Versus Implantable Cardiac Monitors
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DOI：
10.1161/strokeaha.111.676189
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发表时间：
2013-05-01
期刊：
影响因子：
8.3
通讯作者：
Ringelstein, E. Bernd
中科院分区：
文献类型：
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作者：
Ritter, Martin A.;Kochhaeuser, Simon;Ringelstein, E. Bernd
背景和目的：相当数量的隐源性卒中患者患有间歇性心房颤动（iAF），在标准诊断程序中未被检测到。我们研究了植入式心脏监护仪（ICM）在隐源性卒中患者中的可行性，并比较了ICM与7天动态心电图监测的iAF检出率。方法：纳入60例急性隐源性脑卒中患者（中位年龄63岁，四分位数范围48.5-72岁）。ICM于排位赛后13天（四分位数间距10-65天）植入。ICM植入后进行7天动态心电图。结果：ICM检出iAF 10例（17%,95% CI, 7% ~ 26%）。只有1例患者（1.7%;95% CI, 0% ~ 5%）在7天动态心电图监测期间也发生iAF （P=0.0077）。植入后64天（范围1-556天）检测到持续2分钟或更长时间的iAF发作。观察期间无卒中复发。植入过程耐受性良好，无不良事件；日常数据传输协议便于患者操作。结论在门诊随访中，icm植入检测隐源性脑卒中患者iAF是可行的。ICMs的诊断率比7天动态心电图监测高得多。(中风。2013;44:1449 - 1452)。
Background and Purpose-A significant number of patients with cryptogenic stroke suffer from intermittent atrial fibrillation (iAF) which was not detected during the standard diagnostic procedures. We investigated whether implantation of an insertable cardiac monitor (ICM) is feasible in patients with cryptogenic stroke, and compared the iAF detection rate of the ICM with 7-day Holter monitoring.Methods-Sixty patients (median age 63; interquartile range, 48.5-72 years) with acute cryptogenic stroke were included. ICM was implanted 13 days (interquartile range; 10-65 days) after the qualifying event. Seven-day Holter was performed after the ICM was implanted.Results-The iAF was detected by the ICM in 10 patients (17%; 95% CI, 7% to 26%). Only 1 patient (1.7%; 95% CI, 0% to 5%) had iAF during 7-day Holter monitoring as well (P=0.0077). Episodes of iAF lasting 2 minutes or more were detected 64 (range, 1-556) days after implantation. There were no recurrent strokes during the observation period. The implantation procedure was well tolerated with no adverse events; the daily data transmission protocol was easy to handle by the patients.Conclusions-ICM implantation for the detection of iAF during outpatient follow-up is feasible in patients with cryptogenic stroke. ICMs offer a much higher diagnostic yield than 7-day Holter monitoring. (Stroke. 2013;44:1449-1452.)