Long-Term Follow-up of Enhanced Holter-Electrocardiography Monitoring in Acute Ischemic Stroke
- Author:
Rolf WACHTER
1
;
Mark WEBER-KRÜGER
;
Gerhard F. HAMANN
;
Pawel KERMER
;
Jan LIMAN
;
Meinhard MENDE
;
Joachim SEEGERS
;
Katrin WASSER
;
Sonja GRÖSCHEL
;
Timo UPHAUS
;
Holger POPPERT
;
Martin KÖHRMANN
;
Markus ZABEL
;
Ulrich LAUFS
;
Peter U. HEUSCHMANN
;
David CONEN
;
Klaus GRÖSCHEL
;
Author Information
- Publication Type:Original Article
- From:Journal of Stroke 2022;24(1):98-107
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:and Purpose Prolonged electrocardiography (ECG)-monitoring in stroke patients improves the detection of paroxysmal atrial fibrillation (pAF). However, most randomized studies only had short follow-up. We aimed to provide 3-year follow-up data for AF detection and stroke recurrence risk.
Methods:
We randomized 402 patients aged ≥60 years with acute ischemic strokes without AF to either enhanced and prolonged monitoring (EPM; 3×10-day Holter-ECG-monitoring) or standard-of-care (≥24 hours ECG-monitoring). The endpoint of the current analysis was AF within 36 months analyzed by intention to treat. Long-term follow-up was performed for 36 months.
Results:
Two hundred and seventy-four patients (80%) participated in the extended follow-up (median duration of follow-up was 36 months [interquartile range, 12 to 36]). During the first 6 months, more AF was documented in the EPM arm compared to the control arm (13.5% vs. 5.1%; 95% confidence interval, 2.9% to 14.4%; P=0.004). During months 6 to 36, AF was less detected in the EPM intervention arm than in the control arm (2.0% vs. 7.3%; 95% confidence interval, 0.7% to 9.9%; P=0.028). Overall, the detection rate of AF within 36 months was numerically higher within the EPM group (15.0% vs. 11.1%, P=0.30). Numerically less patients in the EPM arm had recurrent ischemic strokes (5.5% vs. 9.1%, P=0.18), transient ischemic attacks (3.0% vs. 4.5%, P=0.44) or died (4.5% vs. 6.6%, P=0.37).
Conclusions:
Enhanced and prolonged ECG monitoring increased AF detection during the first six months, but there was significantly more clinical AF during months 6 to 36 observed in the usual-care arm. This suggests that EPM leads to an earlier detection of clinically relevant AF.
