Diogo C. Haussen, MD
Higgins P, MacFarlane PW, Dawson J, McInnes GT, Langhorne P, and Lees KR. Noninvasive Cardiac Event Monitoring to Detect Atrial Fibrillation AfterIschemic Stroke: A Randomized Controlled Trial. Stroke. 2013
The importance of diagnosing atrial fibrillation as a cause of ischemic stroke cannot be overemphasized. The study by Higgins et al. in the current issue of stroke addresses this important topic.
Considering that the rates of atrial fibrillation detection correlate with the duration of heart monitoring, the authors report the results of a pilot study that hypothesized that 7-days of non-invasive cardiac-event monitoring after stroke would accelerate detection of AF (sustained and non-sustained), and possibly increase the utilization of anticoagulation.
The intervention group encompassed patients that underwent prolonged non-invasive cardiac monitoring (7 days). A small lightweight device that automatically collects cardiac rhythm data possibly representing episodes of arrhythmia through two electrodes was used. These patients were compared to subjects that solely received a baseline EKG and repeated EKGs, and/or 24 hour Holter and/or transthoracic echocardiograms during the evaluation.
One hundred patients were enrolled within a period of 2 weeks after stroke. Sustained paroxysms of atrial fibrillation were detected in 18% of patients undergoing prolonged monitoring versus 2% in the control group (paroxysms of any duration were detected in 44% versus 4%, respectively). Anticoagulant therapy was initiated within 2 weeks in 16% of the interventional group versus none in the controls.
The final trial results may have sufficient power to determine if the increased detection rates will translate into a clinical benefit in reducing ‘relevant clinical endpoints’ (TIAs, strokes, MI and death). Moreover, the study will help to better understand the significance of non-sustained (<20 seconds) episodes of atrial fibrillation.