96 hours ECG monitoring for patients with ischemic cryptogenic stroke or transient ischaemic attack
Giorgia Manina1, Giancarlo Agnelli, Cecilia Becattini
1Division of Internal and Cardiovascular Medicine, Stroke Unit, University of Perugia, Perugia, Italy, giorgia.manina@yahoo.it.
Insights
Prolonged 96-hour ECG monitoring effectively detects intermittent atrial fibrillation (AF) in patients with cryptogenic stroke or TIA. A significant portion of AF episodes were identified beyond the initial 24 hours, highlighting the need for extended monitoring.
Area of Science:
- Cardiology
- Neurology
- Medical Diagnostics
Background:
- Atrial fibrillation (AF) is a common cause of cardioembolic stroke.
- Intermittent AF may not be detected by standard 24-hour ECG monitoring.
- Cryptogenic stroke and transient ischemic attack (TIA) necessitate accurate diagnosis of underlying causes.
Purpose of the Study:
- To assess the diagnostic yield of prolonged 96-hour ECG monitoring for intermittent AF in cryptogenic stroke/TIA patients.
- To determine if AF episodes occur beyond 24 hours of monitoring in this population.
- To evaluate the effectiveness of extended Holter monitoring in identifying AF.
Main Methods:
- Prospective evaluation of consecutive patients with cryptogenic stroke or TIA.
- Standard 12-lead ECG on admission and continuous ECG monitoring (≥24 hours).
- 96-hour Holter ECG monitoring within 30 days of stroke onset.
Main Results:
- Atrial fibrillation was detected in 29 out of 114 patients (24.3%).
- AF was identified within the first 24 hours in 20 patients and after 24 hours in 9 patients.
- One-third of AF cases were diagnosed beyond the initial 24-hour monitoring period.
Conclusions:
- 96-hour ECG monitoring significantly increases the detection rate of AF in patients with cryptogenic stroke or TIA.
- Extended Holter monitoring is crucial for uncovering intermittent AF that might be missed by shorter recordings.
- Findings support the use of prolonged ECG monitoring for comprehensive etiological diagnosis in stroke patients.
Abstract:
Atrial fibrillation (AF) is intermittent in 30% of patients with cardioembolic stroke and, therefore, might not be seen in a single standard ECG recording. The aim of this study was to evaluate if prolonged ECG monitoring (96 h) finds episodes of intermittent AF beyond the 24 h ECG monitoring in patients with cryptogenic stroke or transient ischemic attack (TIA). We prospectively evaluated consecutive patients affected by cryptogenic stroke or TIA who had sinus rhythm on a 12-lead ECG on admission, and during ECG monitoring performed in the acute phase (for at least 24 h). Patients had continuous 96 h Holter ECG monitoring within 30 days from stroke onset. 114 patients were included in the study (mean age 63.1 ± 15.1, 59 males). AF was found in 29 patients (24.3%). In 20 patients, AF was found in the first 24 h of recording, and in nine patients after 24 h. In addition, several other dysrhythmias such as supraventricular ectopic activity (33), ventricular tachycardia (10), sinus pause (4) and sinus-atrial block (1) were found. In patients with cryptogenic stroke or TIA, 96 h ECG monitoring detected a high rate of AF. One-third of AF was seen beyond 24 h of ECG monitoring.
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