Atrial Fibrillation in Patients with Cryptogenic Stroke
Atrial Fibrillation in Patients with Cryptogenic Stroke
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DOI：
10.1056/nejmoa1311376
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发表时间：
2014-06-26
影响因子：
158.5
通讯作者：
Mamdani, Muhammad
中科院分区：
文献类型：
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作者：
Gladstone, David J.;Spring, Melanie;Mamdani, Muhammad
房颤是卒中复发的主要可预防原因，早期发现和治疗至关重要。然而，阵发性心房颤动通常是无症状的，在缺血性卒中或短暂性脑缺血发作（TIA）患者的常规护理中可能未被发现和治疗。方法我们随机分配了572例55岁或以上的患者，没有已知的心房颤动，在过去6个月内有过隐源性缺血性卒中或TIA（标准检查后原因未确定，包括24小时心电图[ECG]），接受额外的无创动态ECG监测，使用30天事件触发记录仪（干预组）或传统的24小时监测仪（对照组）。主要结局是随机分组后90天内新检测到的持续30秒或更长时间的房颤。次要结果包括持续2.5分钟或更长时间的房颤发作和90天时的抗凝状态。280例患者中有45例检测到持续30秒或更长时间的房颤干预组中有9例（16.1%）发生感染，而干预组中有9例（16.1%）发生感染（3.2%）（绝对差异，12.9个百分点; 95%置信区间[CI]，8.0至17.6; P
BACKGROUNDAtrial fibrillation is a leading preventable cause of recurrent stroke for which early detection and treatment are critical. However, paroxysmal atrial fibrillation is often asymptomatic and likely to go undetected and untreated in the routine care of patients with ischemic stroke or transient ischemic attack (TIA).METHODSWe randomly assigned 572 patients 55 years of age or older, without known atrial fibrillation, who had had a cryptogenic ischemic stroke or TIA within the previous 6 months (cause undetermined after standard tests, including 24-hour electrocardiography [ECG]), to undergo additional noninvasive ambulatory ECG monitoring with either a 30-day event-triggered recorder (intervention group) or a conventional 24-hour monitor (control group). The primary outcome was newly detected atrial fibrillation lasting 30 seconds or longer within 90 days after randomization. Secondary outcomes included episodes of atrial fibrillation lasting 2.5 minutes or longer and anticoagulation status at 90 days.RESULTSAtrial fibrillation lasting 30 seconds or longer was detected in 45 of 280 patients (16.1%) in the intervention group, as compared with 9 of 277 (3.2%) in the control group (absolute difference, 12.9 percentage points; 95% confidence interval [CI], 8.0 to 17.6; P