Diagnostic and therapeutic impact of ambulatory electrocardiography in acute stroke.
Detection of paroxysmal atrial fibrillation (PAF) in patients with recent ischemic stroke or TIA suggests a cardioembolic etiology and leads to initiation of oral anticoagulation in suitable candidates. We assessed the diagnostic and therapeutic impact of adding ambulatory electrocardiography (24 hr ECG) to a standardised ischemic stroke workup.


METHODS
We measured the frequency of detection of PAF in consecutive stroke patients who underwent 24 hr ECG that was not diagnosed clinically or on a standard 12-lead ECG.


RESULTS
One hundred forty five ischemic stroke patients were included. 24 hr ECG was obtained in 136 patients (93.8%). Clinically unsuspected PAF was detected on 24 hr ECG in 7 patients (5.1%). The secondary prevention measure changed from antiplatelet agents to oral anticoagulation in 6 of 7 patients.


CONCLUSIONS
Our findings suggest that ambulatory electrocardiography is a valuable diagnostic tool in the workup of stroke patients. Further prospective studies are needed to identify, subtypes of patients in whom the yield of ambulatory electrocardiography is higher.
Vandenbroucke
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E
Department of Neurology, UZ Gasthuisberg, Katholieke Universiteit Leuven, Belgium.
Thijs
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VN
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology