Atrial fibrillation detection using a automated electrocardiographic monitoring in a transient ischaemic attack
Lucio D'Anna1,2, Oishi Sikdar2, Suyin Lim2
1Department of Brain Sciences, Imperial College London, London, UK l.danna@imperial.ac.uk.
Insights
Automated continuous ECG monitoring (ACEM) significantly improved atrial fibrillation detection in transient ischaemic attack (TIA) patients. This enhanced AF detection reduced the risk of recurrent stroke/TIA in a rapid outpatient TIA service.
Area of Science:
- Neurology
- Cardiology
- Medical Technology
Background:
- Transient ischaemic attack (TIA) services face delays in cardiac monitoring, potentially missing atrial fibrillation (AF) and increasing stroke risk.
- Automated continuous ECG monitoring (ACEM) shows promise for AF detection, but its effectiveness in rapid TIA services is unproven.
Purpose of the Study:
- To assess ACEM's impact on reducing cardiac monitoring delays in TIA patients.
- To enhance AF detection rates and determine the effect of rapid ACEM initiation on 6-month recurrent stroke/TIA risk.
Main Methods:
- An observational, prospective study comparing ACEM (phase 2) with routine 24h-Holter ECG (phase 1) in TIA patients.
- Two cohorts were analyzed: phase 1 (n=136) and phase 2 (n=105), with no significant differences in demographics or monitoring duration.
Main Results:
- Newly detected AF rates were significantly higher with ACEM (9.52%) versus routine monitoring (2.21%).
- The 6-month risk of recurrent stroke/TIA was significantly lower in the ACEM group (1%) compared to the routine monitoring group (7.4%).
Conclusions:
- Early initiation of ACEM in rapid TIA services improves AF detection.
- ACEM implementation is associated with a reduced risk of recurrent TIA/stroke.
Background:
The vast majority of the transient ischaemic attacks (TIA) services in UK reported significant delays in the initiation of the routine cardiac monitoring that may result in a significant number of missed atrial fibrillation (AF) paroxysms and increased long-term risk of recurrent stroke. Automated continuous ECG monitoring (ACEM) system has shown promising results in terms of AF detection but it is unclear if ACEM improves AF detection in a rapid outpatient TIA service.
Objectives:
We assessed ACEM in patients with TIA with the aim to significantly reduce the delay to initiate the cardiac monitoring and to enhance the yield of AF detection in these patients. We also aimed to determine the impact of a more rapid initiation of ACEM on the 6-month risk of recurrent stroke/TIA.
Methods:
This is an observational, prospective before (phase 1: 1 July to 31 December 2018) versus after (phase 2: 1 January to 30 June 2019) study of the effect of ACEM, compared with routine initiation of 24h-Holter ECG, in patients with TIA assessed in our service.
Results:
The phase 1 (n=136) and phase 2 (n=105) cohorts did not differ with regards to age, risk factors, duration of cardiac monitoring. The rate of newly detected AF was significantly higher in phase 2 compared with phase 1 (9.52% vs 2.21%, p<0.001). The 6-month risk of recurrent stroke/TIA was significantly lower in phase 2 compared with phase 1 (7.4% vs 1%, p=0.018).
Conclusions:
Early initiation of ACEM improves AF detection after TIA in a rapid TIA service and is associated with a reduced risk of recurrent TIA/stroke.
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