Prevalence and predictors of paroxysmal atrial fibrillation on Holter monitor in patients with stroke or transient ischemic attack.
OBJECTIVE
Our aims were to quantify the yield of Holter monitor for detection of paroxysmal atrial fibrillation (PAF) in patients with stroke and TIA, and to determine potential predictors of PAF to allow more focused testing.


METHODS
We reviewed records of 1128 consecutive patients attending a university stroke clinic from September 2005 to September 2006 and identified 426 patients with definite TIA or stroke. We abstracted clinical, cardiac imaging, and neuroimaging data. Logistic regression analysis was performed to determine independent predictors of PAF on Holter monitor.


RESULTS
Overall, 413 of 426 patients (65 ± 15 years; male, 49.8%) with a definite TIA (53%) or stroke (47%) underwent Holter monitoring for a mean of 22.6 hours. PAF occurred in 39 patients (9.2%) all older than age 55 years. PAF lasting > 30 seconds was evident in 11 patients (2.5%). The other 28 patients had PAF < 30 seconds (6.5%). In multivariate analyses, number of acute (odds ratio [OR], 1.7 for each 1 lesion increase; 95% confidence interval [CI], 1.2-2.6; P = 0.0047) and chronic (OR, 1.6 for each 1 lesion increase; 95% CI, 1.2-2.3; P = 0.0001) infarcts on brain CT, number of chronic infarcts on MRI (OR, 3.0 for each 1 lesion increase; 95% CI, 1.7-5.1; P < 0.0001), and any acute cortical infarct on imaging (OR, 5.8; 95% CI, 1.9-17.8; P = 0.0023) were associated with PAF.


CONCLUSIONS
PAF is present in 9.2% of patients with definite stroke or TIA. Age older than 55 years and presence of acute or chronic brain infarcts on neuroimaging are strongly associated with PAF.
Alhadramy
Osama
O
Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. msaqqur@ualberta.ca
Jeerakathil
Thomas J
TJ
Majumdar
Sumit R
SR
Najjar
Emad
E
Choy
Jonathan
J
Saqqur
Maher
M
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000503:physiopathology*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed