Published Online
on May 20, 2004

A more recent version of this article appeared on July 1, 2004

This Article Full Text (PDF) All Versions of this Article: 35/7/1647    most recent 01.STR.0000131269.69502.d9v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Jabaudon, D. Articles by Sztajzel, R. Search for Related Content PubMed PubMed Citation Articles by Jabaudon, D. Articles by Sztajzel, R. Related Collections Electrophysiology Secondary prevention Arrhythmias, clinical electrophysiology, drugs

Submitted on December 26, 2003
Revised on March 29, 2004
Accepted on March 31, 2004

Usefulness of Ambulatory 7-Day ECG Monitoring for the Detection of Atrial Fibrillation and Flutter After Acute Stroke and Transient Ischemic Attack

Denis Jabaudon MD, PhD^*; Juan Sztajzel MD; Katia Sievert;; Theodor Landis MD; and Roman Sztajzel MD

From the Department of Neurology (D.J, T.L, R.S.) and Cardiology Center, Department of Internal Medicine, (J.S., K.S.), University Hospital Geneva, Geneva, Switzerland.

^* To whom correspondence should be addressed. E-mail: denis.jabaudon{at}hcuge.ch.

Background and Purpose--Although atrial fibrillation (AF) is the most frequent cause of cardioembolic stroke, this arrhythmia remains underdiagnosed, as it is often asymptomatic or intermittent and, thus, may not be detected on standard 12-lead ECG or even 24-hour ECG recording (Holter). In this study, we hypothesized that 7-day ambulatory ECG monitoring using an event-loop recording (ELR) device would detect otherwise occult AF episodes after acute stroke or transient ischemic attack (TIA).

Methods--One hundred forty-nine consecutive patients admitted to our neurology department with an acute stroke or TIA were systematically screened for emboligenic arrhythmias using standard ECG. In the absence of AF on standard ECG, patients underwent 24-hour ECG recording (Holter), which was followed by a 7-day ambulatory ECG monitoring (ELR) in patients with a normal Holter. Patients with previously documented persistent AF, with primary hemorrhagic stroke, or with acute large vessel dissection were not included in the study.

Results--AF was detected in 22 patients. Standard ECG identified AF in 2.7% of the cases at admission (4/149 patients) and in 4.1% of remaining patients within 5 days (6/145). Holter disclosed AF in 5% of patients with a normal standard ECG (7/139 patients), whereas ELR detected AF in 5.7% of patients with a normal standard ECG and normal Holter (5/88 patients).

Conclusions--Following acute stroke or TIA, ELR identified patients with AF, which remained undetected with standard ECG and with Holter. ELR should, therefore, be considered in every patient in whom a cardioembolic mechanism is suspected.

Key words: atrial fibrillation • diagnostic tests • electrocardiography • prevention and control • stroke, cardioembolic

This article has been cited by other articles:

				C. Leclercq, L. Padeletti, R. Cihak, P. Ritter, G. Milasinovic, D. Gras, V. Paul, I.C. Van Gelder, C. Stellbrink, G. Rieger, et al. Incidence of paroxysmal atrial tachycardias in patients treated with cardiac resynchronization therapy and continuously monitored by device diagnostics Europace, October 28, 2009; (2009) eup318v1. [Abstract] [Full Text] [PDF]

				J. G. Morris, E. J. Duffis, and M. Fisher Cardiac Workup of Ischemic Stroke: Can We Improve Our Diagnostic Yield? Stroke, August 1, 2009; 40(8): 2893 - 2898. [Abstract] [Full Text] [PDF]

				A. H. Tayal, M. Tian, K. M. Kelly, S. C. Jones, D. G. Wright, D. Singh, J. Jarouse, J. Brillman, S. Murali, and R. Gupta Atrial fibrillation detected by mobile cardiac outpatient telemetry in cryptogenic TIA or stroke Neurology, November 18, 2008; 71(21): 1696 - 1701. [Abstract] [Full Text] [PDF]

				R. P. Ward, G. Lammertin, D. E. Virnich, T. S. Polonsky, and R. M. Lang Use of Carotid Intima-Media Thickness to Identify Patients With Ischemic Stroke and Transient Ischemic Attack With Low Yield of Cardiovascular Sources of Embolus on Transesophageal Echocardiography Stroke, November 1, 2008; 39(11): 2969 - 2974. [Abstract] [Full Text] [PDF]

				R. Nieuwlaat, T. Dinh, S. B. Olsson, A. J. Camm, A. Capucci, R. G. Tieleman, G. Y.H. Lip, H. J.G.M. Crijns, and on behalf of the Euro Heart Survey Investigators Should we abandon the common practice of withholding oral anticoagulation in paroxysmal atrial fibrillation? Eur. Heart J., April 1, 2008; 29(7): 915 - 922. [Abstract] [Full Text] [PDF]

				N U Weir An update on cardioembolic stroke Postgrad. Med. J., March 1, 2008; 84(989): 133 - 142. [Abstract] [Full Text] [PDF]

				J. Liao, Z. Khalid, C. Scallan, C. Morillo, and M. O'Donnell Noninvasive Cardiac Monitoring for Detecting Paroxysmal Atrial Fibrillation or Flutter After Acute Ischemic Stroke: A Systematic Review Stroke, November 1, 2007; 38(11): 2935 - 2940. [Abstract] [Full Text] [PDF]

				D. Wallmann, D. Tuller, K. Wustmann, P. Meier, J. Isenegger, M. Arnold, H. P. Mattle, and E. Delacretaz Frequent Atrial Premature Beats Predict Paroxysmal Atrial Fibrillation in Stroke Patients: An Opportunity for a New Diagnostic Strategy Stroke, August 1, 2007; 38(8): 2292 - 2294. [Abstract] [Full Text] [PDF]

				R I Dewar, G Y H Lip, and on behalf of the Guidelines Development Group for Identification, diagnosis and assessment of atrial fibrillation Heart, January 1, 2007; 93(1): 25 - 28. [Full Text] [PDF]

				C. Marini, F. De Santis, S. Sacco, T. Russo, L. Olivieri, R. Totaro, and A. Carolei Contribution of Atrial Fibrillation to Incidence and Outcome of Ischemic Stroke: Results From a Population-Based Study Stroke, June 1, 2005; 36(6): 1115 - 1119. [Abstract] [Full Text] [PDF]