title: Continuous stroke unit electrocardiographic monitoring versus 24-hour Holter electrocardiography for detection of paroxysmal atrial fibrillation after stroke.
abstract: OBJECTIVE
  Cardioembolism in paroxysmal atrial fibrillation (pxAF) is a frequent cause of ischemic stroke. Sensitive detection of pxAF after stroke is crucial for adequate secondary stroke prevention; the optimal diagnostic modality to detect pxAF on stroke units is unknown. We compared 24-hour Holter electrocardiography (ECG) with continuous stroke unit ECG monitoring (CEM) for pxAF detection.
  
  
  METHODS
  Patients with acute ischemic stroke or transient ischemic attack were prospectively enrolled. After a 12-channel ECG on admission, all patients received 24-hour Holter ECG and CEM. Additionally, ECG monitoring data underwent automated analysis using dedicated software to identify pxAF. Patients with a history of atrial fibrillation or with atrial fibrillation on the admission ECG were excluded.
  
  
  RESULTS
  Four hundred ninety-six patients (median age, 69 years; 61.5% male) fulfilled all inclusion criteria (ischemic stroke: 80.4%; transient ischemic attack: 19.6%). Median stroke unit stay lasted 88.8 hours (interquartile range, 65.0-122.0). ECG data for automated CEM analysis were available for a median time of 64.0 hours (43.0-89.8). Paroxysmal AF was documented in 41 of 496 patients (8.3%). Of these, Holter detected pxAF in 34.1%; CEM in 65.9%; and automated CEM in 92.7%. CEM and automated CEM detected significantly more patients with pxAF than Holter (P<0.001), and automated CEM detected more patients than CEM (P<0.001).
  
  
  CONCLUSIONS
  Automated analysis of CEM improves pxAF detection in patients with stroke on stroke units compared with 24-hour Holter ECG. The comparative usefulness of prolonged or repetitive Holter ECG recordings requires further evaluation.
authors.affiliation: Department of Neurology, University Heidelberg, INF 400, 69120 Heidelberg, Germany.
authors.forename: Timolaos
authors.initials: T
authors.lastname: Rizos
authors.forename: Janina
authors.initials: J
authors.lastname: Güntner
authors.forename: Ekkehart
authors.initials: E
authors.lastname: Jenetzky
authors.forename: Lars
authors.initials: L
authors.lastname: Marquardt
authors.forename: Christine
authors.initials: C
authors.lastname: Reichardt
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Becker
authors.forename: Roland
authors.initials: R
authors.lastname: Reinhardt
authors.forename: Thomas
authors.initials: T
authors.lastname: Hepp
authors.forename: Paulus
authors.initials: P
authors.lastname: Kirchhof
authors.forename: Elena
authors.initials: E
authors.lastname: Aleynichenko
authors.forename: Peter
authors.initials: P
authors.lastname: Ringleb
authors.forename: Werner
authors.initials: W
authors.lastname: Hacke
authors.forename: Roland
authors.initials: R
authors.lastname: Veltkamp
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation / Q000379:methods*; D006757:Hospital Units; D006801:Humans; D007297:Inpatients; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D010045:Outpatients; D011446:Prospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors