title: Detection and Predictors of Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke and Transient Ischemic Attack Patients in Singapore.
abstract: BACKGROUND
  Detection of paroxysmal atrial fibrillation (pAF) is important for optimal secondary stroke prevention. Data are limited from Asia regarding inpatient occurrence and predictors of pAF to optimize electrocardiographic (ECG) monitoring despite it having nearly two thirds of the world's population and different subtypes of stroke from the West.
  
  
  METHODS
  We analyzed a prospective dataset comprising 370 acute ischemic stroke (AIS) and 25 transient ischemic attack (TIA) patients without known atrial fibrillation who underwent continuous ECG monitoring (CEM) in an acute stroke unit from July 2012 to February 2013. The median duration of monitoring was 61 hours.
  
  
  RESULTS
  There were 31 cases of pAF. The detection rate was 8% for both AIS and TIA patients. It occurred less often in lacunar infarcts (3%) compared to nonlacunar infarcts (10%) (P = .047). The detection rates in cryptogenic infarcts (10%) and infarcts of known causes (7%) were not significantly different (P = .224). The predictors of pAF according to logistic regression were hemorrhagic conversion (P = .006), scattered infarcts (P = .007), radiological cardiomegaly (P = .007), occlusion of symptomatic artery (P = .023), and older age (P < .001).
  
  
  CONCLUSIONS
  pAF occurred in 8% of AIS and TIA in a hospitalized cohort of Asian patients. All patients without known atrial fibrillation should undergo CEM for at least 3 days during hospitalization and priority given to patients with predictors of pAF in centers with resource constraints.
authors.affiliation: Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital Campus, Singapore. Electronic address: sze_haur_lee@nni.com.sg.
authors.forename: Sze Haur
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Health Services & Outcomes Research, National Healthcare Group, Singapore.
authors.forename: Yan
authors.initials: Y
authors.lastname: Sun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D020521:Stroke / Q000150:complications* / Q000453:epidemiology; D015898:Tomography Scanners, X-Ray Computed
keywords: Asian; ECG; Stroke; atrial fibrillation; transient ischemic attack