Continuous ECG monitoring for tracking down atrial fibrillation after stroke: Holter or automated analysis strategy?
Laurent Suissa1, Sylvain Lachaud, Marie-Hélène Mahagne
1Stroke Center, University Hospital of Nice, Nice, France.
Insights
Detecting atrial fibrillation (AF) in stroke patients is crucial for preventing recurrent strokes. Continuous ECG monitoring (CEM) with manual Holter analysis (hCEM) yielded the highest AF detection rates compared to software-based analysis (aCEM).
Area of Science:
- Cardiology
- Neurology
- Medical Technology
Background:
- Atrial fibrillation (AF) detection in stroke patients is vital for preventing recurrent strokes.
- Optimal use of continuous ECG monitoring (CEM) for AF detection remains unclear.
- This study compares standard 24-hour Holter ECG with two CEM analysis strategies.
Purpose of the Study:
- To compare the effectiveness of different continuous ECG monitoring (CEM) analysis strategies for detecting atrial fibrillation (AF) in stroke patients.
- To determine the optimal method for AF detection to prevent recurrent AF-related strokes.
Main Methods:
- Prospective enrollment of consecutive ischemic stroke patients.
- AF-naïve patients received continuous ECG monitoring (CEM) during hospitalization.
- Comparison of manual Holter analysis (hCEM) versus semiautomated software analysis (aCEM) for CEM data.
Main Results:
- Of 362 patients, 304 were AF-naïve and underwent CEM for a median of 5.3 days.
- Manual Holter analysis (hCEM) detected 13.8% new AF cases, significantly higher than semiautomated analysis (aCEM) at 10.2%.
- Both hCEM and aCEM significantly increased AF detection rates compared to initial 24-hour Holter monitoring.
Conclusions:
- Early and prolonged continuous ECG monitoring (CEM) improves AF detection in stroke patients.
- Manual Holter analysis (hCEM) demonstrates the highest AF detection rate.
- Semiautomated analysis (aCEM) may have lower specificity and sensitivity due to reliance on ventricular rhythm analysis.
Background:
Tracking down atrial fibrillation (AF) in the stroke unit is a relevant challenge for the prevention of recurrent AF-related stroke. The optimal terms of use of continuous ECG monitoring (CEM) are unknown. We compared 24-hour routine Holter ECG with two different CEM analysis strategies for AF detection.
Methods:
We prospectively enrolled consecutive ischemic stroke patients. All AF-naïve patients received CEM during hospitalization. Two methods for reading CEM data were compared: manual analysis using the Holter function (hCEM) and semiautomated analysis using software (aCEM). The McNemar test was used to compare AF detection rates.
Results:
Of the 362 patients included, 58 (16.0%) were non-AF-naïve patients and 304 were AF-naïve patients. AF-Naïve patients underwent CEM with a median duration of 5.3 days (3.4-9.7). We detected 22 new AF cases (7.2%) with first-24-hour hCEM, 31 (10.2%) with aCEM, and 42 (13.8%) with hCEM. hCEM and aCEM both significantly increased the AF detection rate compared to first-24-hour hCEM. hCEM detected more new AF cases than aCEM (+3.6%, p = 0.003).
Conclusions:
In stroke patients, early and prolonged aCEM and hCEM both increase the AF detection rate compared to first-24-hour hCEM. hCEM gives the best AF detection rate. We suggest that in aCEM, detection based only on the ventricular rhythm analysis explains its lower specificity and sensitivity.
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