title: Detection of paroxysmal atrial fibrillation or flutter in patients with acute ischemic stroke or transient ischemic attack by Holter monitoring.
abstract: OBJECTIVE
  Paroxysmal atrial fibrillation and flutter are strong risk factors for stroke. Due to high recurrence rate of ischemic events and given the benefit of oral anticoagulation over antiplatelet drugs, it is important to identify this arrhythmia. Unfortunately, paroxysmal AF or flutter is asymptomatic in majority and therefore, difficult to detect.
  
  
  METHODS
  Consecutive patients presenting with symptoms of acute ischemic stroke or transient ischemic attack were included. All patients free of AF or flutter on presentation underwent 24 h Holter monitoring within 7 days of admission.
  
  
  RESULTS
  Overall, fifty two (52) patients (mean age 59.51 ± 13.45 years) with acute stroke (80.8%) and TIA (19.8%) underwent 24 h Holter monitoring. Paroxysmal AF was detected in 3 cases (5.8%), all 3 patients had acute stroke and were older than age 60 years. Type of stroke was the only factor which was associated with greater risk of having paroxysmal AF or flutter, AF accounted for 50% cases (2 out of 4) of clinically suspected cardio embolic stroke.
  
  
  CONCLUSIONS
  Screening consecutive patients with ischemic stroke with routine Holter monitoring will identify new atrial fibrillation/flutter in approximately one in 17 patients. Older age and type of stroke are strongly associated with increased risk. By carefully selecting the patients, the detection rates could be further increased.
authors.affiliation: Senior Resident, Department of Cardiology, SMS Medical College, Jaipur, Rajasthan, India. Electronic address: sandydr19481@gmail.com.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Thakkar
authors.affiliation: Professor, Department of Cardiology, SMS Medical College, Jaipur, Rajasthan, India.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Bagarhatta
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology; D001282:Atrial Flutter / Q000175:diagnosis* / Q000453:epidemiology; D015331:Cohort Studies; D003937:Diagnosis, Differential; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007194:India; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology; D013614:Tachycardia, Paroxysmal / Q000175:diagnosis / Q000453:epidemiology
keywords: Acute ischemic stroke; Atrial flutter; Holter monitoring; Paroxysmal atrial fibrillation; Transient ischemic attack