Patients were enrolled in the study 4–7 days after admission to the stroke unit. The patients were also screened for other common non-arrhythmic causes of cardiac thromboembolism. In all patients, carotid artery stenosis and any relevant arrhythmic findings in 24 h Holter (i.e., supraventricular runs ≥5 QRS, AF) were excluded. We analyzed 72 patients (aged 59 ± 7 years, 44 males) with ischemic stroke with no significant disability and cognitive impairment. The aim of the study was to evaluate 72 h Holter, 7 day Holter monitoring, and intermittent single-lead ECG monitoring strategy to identify cases with AF and SVT runs in patients with CIS in whom 24 h Holter was negative for arrhythmia.Īdditionally, correlation of symptoms, clinical characteristics, and echocardiographic findings were evaluated. Any effort should be made to identify the groups, which would benefit from a broader and more detailed diagnostic approach to seek occult arrhythmia. It seems that more than one modality should be used to increase the rate of confirmed AF in poststroke patients. Due to low cost and good specificity in arrhythmia detection, they are being tested in many conditions where a proper diagnosis is crucial for further treatment. Patient-activated, handheld, single-lead ECG event recorders have been proposed as a useful tool in symptomatic patients (dizziness, palpitations), and some clinical settings are even more cost-effective than conventional 24 h or 48 h Holter-ECG monitoring. ECG recorders of longer duration are rarely available. Less sensitive but more available and affordable options include extended (>48–72 h) Holter monitoring, continuous ECG recording with telemetry, loop recorders and patient activated (noncontinuous) repeated ambulatory ECG recorders.ħ day non-invasive ECG continuous monitoring is commonly available and despite some drawbacks – acceptable for patients. On the contrary, ILRs are good diagnostic tools, but the cost and invasive procedure of implantation make the tool less acceptable for both patients and healthcare systems. While cardiac implantable electric devices (CIEDs) are a source of valuable data, they are not a diagnostic option in the general population for obvious reasons. The most precise data on AF prevalence in stroke survivors come from studies in pacemaker/implantable cardioverter-defibrillator (ICD) patients and from studies utilizing implantable loop recorders (ILRs). It is well recognized that the longer the time of monitoring is, the higher the prevalence of detected arrhythmic episodes. Despite current guidelines recommending >48–72 h recording for AF screening after stroke, a 12-lead electrocardiogram (ECG) and 24 h Holter monitoring is a routine screening tool in stroke survivors. Ĭonsidering AF is a leading preventable cause of recurrent stroke, detection of AF after cryptogenic stroke is crucial for further therapy and prognosis. Other supraventricular arrhythmias, including multiple PACs and particularly short supraventricular tachycardia (SVT) runs, seem to be an important predictor of AF and recurrent stroke. Paroxysmal AF is often asymptomatic and is likely to be undetected in patients with ischemic stroke. The prevalence of AF in cryptogenic stroke population ranges from below 10% to >25% depending on the timing, duration, and method of monitoring. Recent studies show that in many cases of cryptogenic ischemic stroke (CIS), the cause is attributable to silent atrial fibrillation (silent AF). An origin of an acute stroke remains unknown in 20–40%.
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