Cryptogenic Stroke and Underlying Atrial Fibrillation
Cryptogenic Stroke and Underlying Atrial Fibrillation
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DOI：
10.1056/nejmoa1313600
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发表时间：
2014-06-26
影响因子：
158.5
通讯作者：
Brachmann, Johannes
中科院分区：
文献类型：
--
作者：
Sanna, Tommaso;Diener, Hans-Christoph;Brachmann, Johannes
背景：目前的指南建议在缺血性中风后至少进行24小时的心电监测，以排除心房颤动。然而，最有效的监测持续时间和类型尚未确定，尽管在20%至40%的病例(隐源性中风)中进行了完整的诊断评估，但缺血性中风的原因仍不确定。我们对441名患者进行了一项随机对照研究，以评估使用可插入式心脏监测器(ICM)进行长期监测是否比传统的随访(对照)更有效地检测隐源性卒中患者的心房颤动。40岁或40岁以上的患者在至少24小时的心电监测期间没有房颤的证据，在指数事件后90天内进行随机分组。主要终点是6个月内首次检测到房颤的时间(持续30秒)。次要终点包括在12个月内首次检测到房颤的时间。结果6个月后，ICM组(19例)房颤发生率为8.9%，对照组(3例)为1.4%(危险比为6.4；95%可信区间[CI]为1.9~21.7；P
BACKGROUNDCurrent guidelines recommend at least 24 hours of electrocardiographic (ECG) monitoring after an ischemic stroke to rule out atrial fibrillation. However, the most effective duration and type of monitoring have not been established, and the cause of ischemic stroke remains uncertain despite a complete diagnostic evaluation in 20 to 40% of cases (cryptogenic stroke). Detection of atrial fibrillation after cryptogenic stroke has therapeutic implications.METHODSWe conducted a randomized, controlled study of 441 patients to assess whether long-term monitoring with an insertable cardiac monitor (ICM) is more effective than conventional follow-up (control) for detecting atrial fibrillation in patients with cryptogenic stroke. Patients 40 years of age or older with no evidence of atrial fibrillation during at least 24 hours of ECG monitoring underwent randomization within 90 days after the index event. The primary end point was the time to first detection of atrial fibrillation (lasting >30 seconds) within 6 months. Among the secondary end points was the time to first detection of atrial fibrillation within 12 months. Data were analyzed according to the intention-to-treat principle.RESULTSBy 6 months, atrial fibrillation had been detected in 8.9% of patients in the ICM group (19 patients) versus 1.4% of patients in the control group (3 patients) (hazard ratio, 6.4; 95% confidence interval [CI], 1.9 to 21.7; P