Diagnostic and therapeutic impact of ambulatory electrocardiography in acute stroke
1Department of Neurology, UZ Gasthuisberg, Katholieke Universiteit Leuven, Belgium.
Insights
Ambulatory electrocardiography (24 hr ECG) effectively detects paroxysmal atrial fibrillation (PAF) in stroke patients, leading to crucial changes in secondary prevention strategies. This diagnostic tool aids in identifying cardioembolic sources and guiding anticoagulation therapy.
Area of Science:
- Cardiology
- Neurology
- Medical Diagnostics
Background:
- Paroxysmal atrial fibrillation (PAF) detection in ischemic stroke or TIA patients indicates a cardioembolic source.
- Initiation of oral anticoagulation is standard for suitable candidates post-diagnosis.
- Standard stroke workups may not always detect intermittent arrhythmias like PAF.
Purpose of the Study:
- To evaluate the diagnostic yield of adding ambulatory electrocardiography (24 hr ECG) to standard ischemic stroke workup.
- To assess the therapeutic impact of detecting PAF via 24 hr ECG on secondary prevention strategies.
Main Methods:
- A cohort of consecutive ischemic stroke patients underwent a standardized workup including 24 hr ECG.
- The study measured the detection rate of PAF using 24 hr ECG in patients without prior clinical or standard 12-lead ECG diagnosis.
- Patient data included demographics and treatment changes.
Main Results:
- 145 ischemic stroke patients were included; 136 (93.8%) received 24 hr ECG.
- Clinically unsuspected PAF was detected in 7 patients (5.1%) via 24 hr ECG.
- Secondary prevention changed from antiplatelet agents to oral anticoagulation in 6 of these 7 patients.
Conclusions:
- Ambulatory electrocardiography is a valuable diagnostic tool for stroke patients.
- The detection of PAF via 24 hr ECG significantly impacts secondary prevention strategies.
- Further research is needed to identify patient subgroups benefiting most from this diagnostic approach.
Unlabelled:
Detection of paroxysmal atrial fibrillation (PAF) in patients with recent ischemic stroke or TIA suggests a cardioembolic etiology and leads to initiation of oral anticoagulation in suitable candidates. We assessed the diagnostic and therapeutic impact of adding ambulatory electrocardiography (24 hr ECG) to a standardised ischemic stroke workup.
Methods:
We measured the frequency of detection of PAF in consecutive stroke patients who underwent 24 hr ECG that was not diagnosed clinically or on a standard 12-lead ECG.
Results:
One hundred forty five ischemic stroke patients were included. 24 hr ECG was obtained in 136 patients (93.8%). Clinically unsuspected PAF was detected on 24 hr ECG in 7 patients (5.1%). The secondary prevention measure changed from antiplatelet agents to oral anticoagulation in 6 of 7 patients.
Conclusion:
Our findings suggest that ambulatory electrocardiography is a valuable diagnostic tool in the workup of stroke patients. Further prospective studies are needed to identify, subtypes of patients in whom the yield of ambulatory electrocardiography is higher.
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