title: Detection of paroxysmal atrial fibrillation by prolonged electrocardiographic recording after ischaemic stroke in patients aged<60years: a study with 21-day recording using the SpiderFlash(®) monitor.
abstract: BACKGROUND
  Many studies have suggested that longer duration of cardiac monitoring is suitable for the detection of occult paroxysmal atrial fibrillation (AF) after stroke; however, most studies involved patients aged≥65years - a population with a high stroke rate.
  
  
  OBJECTIVE
  To assess the incidence of paroxysmal AF in unselected young patients presenting with stroke.
  
  
  METHODS
  We included consecutive patients aged<60years with a stroke diagnosis on magnetic resonance imaging. Aetiological screening included clinical history and examination, and biological and cardiac tests. Patients were included if they had no history of AF and if a 24-hour electrocardiogram recording detected no AF or atrial flutter. Patients wore the SpiderFlash(®) monitor for 21days after discharge from hospital. The primary outcome was detection of paroxysmal AF episodes lasting>30seconds during monitoring. The secondary outcome was detection of paroxysmal AF episodes lasting<30seconds and any arrhythmia during monitoring.
  
  
  RESULTS
  Among the 56 patients included (mean age 48±9years), 39 had cryptogenic stroke (CS) and 17 had stroke of known cause (SKC). Cardiac monitoring was achieved in 54 patients (37 CS, 17 SKC); one CS patient had a paroxysmal AF episode lasting>30seconds and one CS patient had a paroxysmal AF episode lasting<30seconds (versus no patients in the SKC group). Two CS patients and one SKC patient presented numerous premature atrial complexes. Non-sustained ventricular tachycardia was detected in one CS patient.
  
  
  CONCLUSIONS
  This prospective observational study showed a low rate of paroxysmal AF among young patients presenting with stroke, on the basis of 21-day cardiac monitoring. This result highlights the need to identify patients who would benefit from such long monitoring.
authors: Department of Cardiology, Campus University Teaching Hospital, Lomé, Togo.
authors: Komlavi
authors: K
authors: Yayehd
authors: Department of Cardiology, Annecy Hospital, Annecy, 74370 Metz-Tessy, France.
authors: Didier
authors: D
authors: Irles
authors: Department of Cardiology, Annecy Hospital, Annecy, 74370 Metz-Tessy, France.
authors: Chrystelle
authors: C
authors: Akret
authors: Department of Neurology, Annecy Hospital, Annecy, 74370 Metz-Tessy, France.
authors: Wilfried
authors: W
authors: Vadot
authors: Department of Neurology, Annecy Hospital, Annecy, 74370 Metz-Tessy, France.
authors: Gilles
authors: G
authors: Rodier
authors: Department of Cardiology, Annecy Hospital, Annecy, 74370 Metz-Tessy, France.
authors: Toufek
authors: T
authors: Berremili
authors: Department of Cardiology, Annecy Hospital, Annecy, 74370 Metz-Tessy, France.
authors: Sophie
authors: S
authors: Perenet
authors: Department of Cardiology, Annecy Hospital, Annecy, 74370 Metz-Tessy, France.
authors: Marie
authors: M
authors: Chevallier-Grenot
authors: Department of Cardiology, Annecy Hospital, Annecy, 74370 Metz-Tessy, France. Electronic address: loic.belle@wanadoo.fr.
authors: Loïc
authors: L
authors: Belle
authors: Department of Cardiology, Annecy Hospital, Annecy, 74370 Metz-Tessy, France.
authors: Antoine
authors: A
authors: Dompnier
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D002545:Brain Ischemia / Q000150:complications; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000150:complications; D013997:Time Factors
keywords: Accident vasculaire cérébral ischémique; Enregistrement électrocardiographique externe de longue durée; Fibrillation auriculaire paroxystique; Ischaemic stroke; Long external cardiac monitoring; Paroxysmal atrial fibrillation; Patients jeunes; Young patients