Second look Holter ECG in neurorehabilitation
Abstract Background Many stroke survivors suffer recurrent stroke because paroxysmal atrial fibrillation (AF) was missed and no preventive anticoagulation initiated. This prospective cohort study determined the added diagnostic yield of second-look 24-h electrocardiographic recording (ECG) in a popu...
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doaj-129267eccce94f23a66d78db922a22222020-12-20T12:22:15ZengBMCNeurological Research and Practice2524-34892019-12-01111810.1186/s42466-019-0046-9Second look Holter ECG in neurorehabilitationStefan Knecht0Sebastian Petsch1Paulus Kirchhof2Bettina Studer3Mauritius HospitalMauritius HospitalUniversity of Birmingham, Centre of Cardiovascular Sciences and SWBH NHS trustMauritius HospitalAbstract Background Many stroke survivors suffer recurrent stroke because paroxysmal atrial fibrillation (AF) was missed and no preventive anticoagulation initiated. This prospective cohort study determined the added diagnostic yield of second-look 24-h electrocardiographic recording (ECG) in a population at high risk for AF: patients who suffered a stroke of such severity that they require inpatient neurorehabilitation. Methods We enrolled 508 patients with ischemic stroke admitted to post-acute inpatient neurorehabilitation and determined whether AF was detected during acute care at the referring hospital. Second-look baseline and 24-h Holter ECG were then conducted during neurorehabilitation. Primary outcome was number of newly detected AF with duration of > 30 s; secondary outcomes were number of newly detected absolute arrhythmia of 10–30 s and < 10 s duration. For comparison, we further enrolled 100 patients with hemorrhagic stroke without history of AF (age = 72 + 11 years, 51% female). Results In 206 of the 508 ischemic stroke patients, AF had been detected during acute phase work-up (age = 78 + 10 years, 55% female). For the remaining 302 ischemic stroke patients, no AF was detected during acute phase work-up (age = 74 + 9 years; 47% female). Second-look 24-h ECG showed previously missed AF of > 30 s in 20 of these patients, i.e. 6.6% of the sample, and shorter absolute arrhythmia in 50 patients (i.e. 16.5%). Conclusions Second-look 24-Hour ECG performed during post-acute inpatient neurorehabilitation has a high diagnostic yield and should become a standard component of recurrent stroke prevention.https://doi.org/10.1186/s42466-019-0046-9Atrial fibrillationStrokeNeurorehabilitationHolter ECG |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Stefan Knecht Sebastian Petsch Paulus Kirchhof Bettina Studer |
spellingShingle |
Stefan Knecht Sebastian Petsch Paulus Kirchhof Bettina Studer Second look Holter ECG in neurorehabilitation Neurological Research and Practice Atrial fibrillation Stroke Neurorehabilitation Holter ECG |
author_facet |
Stefan Knecht Sebastian Petsch Paulus Kirchhof Bettina Studer |
author_sort |
Stefan Knecht |
title |
Second look Holter ECG in neurorehabilitation |
title_short |
Second look Holter ECG in neurorehabilitation |
title_full |
Second look Holter ECG in neurorehabilitation |
title_fullStr |
Second look Holter ECG in neurorehabilitation |
title_full_unstemmed |
Second look Holter ECG in neurorehabilitation |
title_sort |
second look holter ecg in neurorehabilitation |
publisher |
BMC |
series |
Neurological Research and Practice |
issn |
2524-3489 |
publishDate |
2019-12-01 |
description |
Abstract Background Many stroke survivors suffer recurrent stroke because paroxysmal atrial fibrillation (AF) was missed and no preventive anticoagulation initiated. This prospective cohort study determined the added diagnostic yield of second-look 24-h electrocardiographic recording (ECG) in a population at high risk for AF: patients who suffered a stroke of such severity that they require inpatient neurorehabilitation. Methods We enrolled 508 patients with ischemic stroke admitted to post-acute inpatient neurorehabilitation and determined whether AF was detected during acute care at the referring hospital. Second-look baseline and 24-h Holter ECG were then conducted during neurorehabilitation. Primary outcome was number of newly detected AF with duration of > 30 s; secondary outcomes were number of newly detected absolute arrhythmia of 10–30 s and < 10 s duration. For comparison, we further enrolled 100 patients with hemorrhagic stroke without history of AF (age = 72 + 11 years, 51% female). Results In 206 of the 508 ischemic stroke patients, AF had been detected during acute phase work-up (age = 78 + 10 years, 55% female). For the remaining 302 ischemic stroke patients, no AF was detected during acute phase work-up (age = 74 + 9 years; 47% female). Second-look 24-h ECG showed previously missed AF of > 30 s in 20 of these patients, i.e. 6.6% of the sample, and shorter absolute arrhythmia in 50 patients (i.e. 16.5%). Conclusions Second-look 24-Hour ECG performed during post-acute inpatient neurorehabilitation has a high diagnostic yield and should become a standard component of recurrent stroke prevention. |
topic |
Atrial fibrillation Stroke Neurorehabilitation Holter ECG |
url |
https://doi.org/10.1186/s42466-019-0046-9 |
work_keys_str_mv |
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