Second look Holter ECG in neurorehabilitation
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(2019) 1:41
Neurological Research and Practice
RESEARCH ARTICLE
Open Access
Second look Holter ECG in neurorehabilitation Stefan Knecht1,2* , Sebastian Petsch1,2, Paulus Kirchhof3,4 and Bettina Studer1,2
Abstract Background: Many stroke survivors suffer recurrent stroke because paroxysmal atrial fibrillation (AF) was missed and no preventive anticoagulation initiated. This prospective cohort study determined the added diagnostic yield of second-look 24-h electrocardiographic recording (ECG) in a population at high risk for AF: patients who suffered a stroke of such severity that they require inpatient neurorehabilitation. Methods: We enrolled 508 patients with ischemic stroke admitted to post-acute inpatient neurorehabilitation and determined whether AF was detected during acute care at the referring hospital. Second-look baseline and 24-h Holter ECG were then conducted during neurorehabilitation. Primary outcome was number of newly detected AF with duration of > 30 s; secondary outcomes were number of newly detected absolute arrhythmia of 10–30 s and < 10 s duration. For comparison, we further enrolled 100 patients with hemorrhagic stroke without history of AF (age = 72 + 11 years, 51% female). Results: In 206 of the 508 ischemic stroke patients, AF had been detected during acute phase work-up (age = 78 + 10 years, 55% female). For the remaining 302 ischemic stroke patients, no AF was detected during acute phase work-up (age = 74 + 9 years; 47% female). Second-look 24-h ECG showed previously missed AF of > 30 s in 20 of these patients, i.e. 6.6% of the sample, and shorter absolute arrhythmia in 50 patients (i.e. 16.5%). Conclusions: Second-look 24-Hour ECG performed during post-acute inpatient neurorehabilitation has a high diagnostic yield and should become a standard component of recurrent stroke prevention. Keywords: Atrial fibrillation, Stroke, Neurorehabilitation, Holter ECG
Introduction Atrial fibrillation (AF) is the leading preventable cause of recurrent stroke but easily escapes detection when paroxysmal. Moreover, short length of stay in acute stroke care adds to the diagnostic challenge. As of yet, we have no basis for anticoagulant treatment of patients with embolic stroke of undetermined source without documentation of AF [1–3]. Therefore, detection of AF remains a cornerstone for overall prevention of recurrent stroke. But, it is still unclear who should be monitored, when, and for how long [4]. Current stroke guidelines recommend 24-h electrocardiographic (ECG) monitoring [5, 6]; yet previous research indicates that a considerable portion of AF is missed with this standard work-up [7]. * Correspondence: [email protected] 1 Mauritius Hospital, Strümper Straße 111, 40670 Meerbusch, Germany 2 Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany Full list of author information is available at the end of the article
Prolonged continuous ECG monitoring with long-term non-invasive or implantable monitor systems might be a sol
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