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Clinical predictors to identify paroxysmal atrial fibrillation after ischaemic stroke.

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Title: Clinical predictors to identify paroxysmal atrial fibrillation after ischaemic stroke.
Authors: Wohlfahrt, J., Stahrenberg, R., Weber‐Krüger, M., Gröschel, S., Wasser, K., Edelmann, F., Seegers, J., Wachter, R., Gröschel, K.
Source: European Journal of Neurology. Jan2014, Vol. 21 Issue 1, p21-27. 7p.
Subjects: Atrial fibrillation, Ischemia, Cerebrovascular disease, Algorithm research, Coronary artery bypass
Abstract: Background and purpose Detection of paroxysmal atrial fibrillation (p AF) after an ischaemic cerebrovascular event is of imminent interest, because oral anticoagulation as a highly effective secondary preventive treatment is available. Whereas permanent atrial fibrillation ( AF) can be detected during routine electrocardiogram ( ECG), longer detection duration will detect more p AF but might be resource consuming. The current study tried to identify clinical predictors for p AF detected during long-term Holter ECG and clinical follow-up. Methods Patients with acute ischaemic stroke were prospectively investigated with an intensified algorithm to detect p AF (7-day Holter ECG, follow-up investigations after 90 days and 1 year). Results Two hundred and eighty-one patients were included, 44 of whom had to be excluded since they presented with permanent AF and another 13 patients had to be excluded due to other causes leaving 224 patients (mean age 68.5 years, 58.5% male). Twenty-nine (12.9%) patients could be identified to have p AF during prolonged Holter monitoring, an additional 13 (5.8%) after follow-up investigations. Multivariate analysis identified advanced age [odds ratio ( OR) 1.05, 95% confidence interval ( CI) 1.01-1.08] as well as clinical symptoms >24 h ( OR 5.17, 95% CI 1.73-15.48) and a history of coronary artery disease ( OR 3.14, 95% CI 1.35-7.28) to be predictive for the detection of p AF. Conclusions In acute stroke patients with advanced age, history of coronary artery disease and clinical symptoms >24 h, a prolonged Holter ECG monitoring and follow-up is warranted to identify p AF. This could increase the detection rate of patients requiring anticoagulation and may be able to reduce the risk of recurrent stroke in the case of successful anticoagulation of these patients. [ABSTRACT FROM AUTHOR]
Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Clinical predictors to identify paroxysmal atrial fibrillation after ischaemic stroke.
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  Data: <searchLink fieldCode="AR" term="%22Wohlfahrt%2C+J%2E%22">Wohlfahrt, J.</searchLink><br /><searchLink fieldCode="AR" term="%22Stahrenberg%2C+R%2E%22">Stahrenberg, R.</searchLink><br /><searchLink fieldCode="AR" term="%22Weber‐Krüger%2C+M%2E%22">Weber‐Krüger, M.</searchLink><br /><searchLink fieldCode="AR" term="%22Gröschel%2C+S%2E%22">Gröschel, S.</searchLink><br /><searchLink fieldCode="AR" term="%22Wasser%2C+K%2E%22">Wasser, K.</searchLink><br /><searchLink fieldCode="AR" term="%22Edelmann%2C+F%2E%22">Edelmann, F.</searchLink><br /><searchLink fieldCode="AR" term="%22Seegers%2C+J%2E%22">Seegers, J.</searchLink><br /><searchLink fieldCode="AR" term="%22Wachter%2C+R%2E%22">Wachter, R.</searchLink><br /><searchLink fieldCode="AR" term="%22Gröschel%2C+K%2E%22">Gröschel, K.</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22European+Journal+of+Neurology%22">European Journal of Neurology</searchLink>. Jan2014, Vol. 21 Issue 1, p21-27. 7p.
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  Data: <searchLink fieldCode="DE" term="%22Atrial+fibrillation%22">Atrial fibrillation</searchLink><br /><searchLink fieldCode="DE" term="%22Ischemia%22">Ischemia</searchLink><br /><searchLink fieldCode="DE" term="%22Cerebrovascular+disease%22">Cerebrovascular disease</searchLink><br /><searchLink fieldCode="DE" term="%22Algorithm+research%22">Algorithm research</searchLink><br /><searchLink fieldCode="DE" term="%22Coronary+artery+bypass%22">Coronary artery bypass</searchLink>
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  Label: Abstract
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  Data: Background and purpose Detection of paroxysmal atrial fibrillation (p AF) after an ischaemic cerebrovascular event is of imminent interest, because oral anticoagulation as a highly effective secondary preventive treatment is available. Whereas permanent atrial fibrillation ( AF) can be detected during routine electrocardiogram ( ECG), longer detection duration will detect more p AF but might be resource consuming. The current study tried to identify clinical predictors for p AF detected during long-term Holter ECG and clinical follow-up. Methods Patients with acute ischaemic stroke were prospectively investigated with an intensified algorithm to detect p AF (7-day Holter ECG, follow-up investigations after 90 days and 1 year). Results Two hundred and eighty-one patients were included, 44 of whom had to be excluded since they presented with permanent AF and another 13 patients had to be excluded due to other causes leaving 224 patients (mean age 68.5 years, 58.5% male). Twenty-nine (12.9%) patients could be identified to have p AF during prolonged Holter monitoring, an additional 13 (5.8%) after follow-up investigations. Multivariate analysis identified advanced age [odds ratio ( OR) 1.05, 95% confidence interval ( CI) 1.01-1.08] as well as clinical symptoms >24 h ( OR 5.17, 95% CI 1.73-15.48) and a history of coronary artery disease ( OR 3.14, 95% CI 1.35-7.28) to be predictive for the detection of p AF. Conclusions In acute stroke patients with advanced age, history of coronary artery disease and clinical symptoms >24 h, a prolonged Holter ECG monitoring and follow-up is warranted to identify p AF. This could increase the detection rate of patients requiring anticoagulation and may be able to reduce the risk of recurrent stroke in the case of successful anticoagulation of these patients. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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