J Stroke.  2022 Jan;24(1):98-107. 10.5853/jos.2021.01207.

Long-Term Follow-up of Enhanced Holter-Electrocardiography Monitoring in Acute Ischemic Stroke

• Wachter R
• Weber-Krüger M
• Hamann GF
• Kermer P
• Liman J
• Mende M
• Seegers J
• Wasser K
• Gröschel S
• Uphaus T
• Poppert H
• Köhrmann M
• Zabel M
• Laufs U
• Heuschmann PU
• Conen D
• Gröschel K
• on Behalf of the Find-AF_RANDOMISED Investigators and Coordinators

• KMID: 2525335
• DOI: http://doi.org/10.5853/jos.2021.01207

Abstract

Background and Purpose
Prolonged electrocardiography (ECG)-monitoring in stroke patients improves the detection of paroxysmal atrial fibrillation (pAF). However, most randomized studies only had short follow-up. We aimed to provide 3-year follow-up data for AF detection and stroke recurrence risk.
Methods

We randomized 402 patients aged ≥60 years with acute ischemic strokes without AF to either enhanced and prolonged monitoring (EPM; 3×10-day Holter-ECG-monitoring) or standard-of-care (≥24 hours ECG-monitoring). The endpoint of the current analysis was AF within 36 months analyzed by intention to treat. Long-term follow-up was performed for 36 months.
Results

Two hundred and seventy-four patients (80%) participated in the extended follow-up (median duration of follow-up was 36 months [interquartile range, 12 to 36]). During the first 6 months, more AF was documented in the EPM arm compared to the control arm (13.5% vs. 5.1%; 95% confidence interval, 2.9% to 14.4%; P=0.004). During months 6 to 36, AF was less detected in the EPM intervention arm than in the control arm (2.0% vs. 7.3%; 95% confidence interval, 0.7% to 9.9%; P=0.028). Overall, the detection rate of AF within 36 months was numerically higher within the EPM group (15.0% vs. 11.1%, P=0.30). Numerically less patients in the EPM arm had recurrent ischemic strokes (5.5% vs. 9.1%, P=0.18), transient ischemic attacks (3.0% vs. 4.5%, P=0.44) or died (4.5% vs. 6.6%, P=0.37).
Conclusions

Enhanced and prolonged ECG monitoring increased AF detection during the first six months, but there was significantly more clinical AF during months 6 to 36 observed in the usual-care arm. This suggests that EPM leads to an earlier detection of clinically relevant AF.

Keyword

Stroke; Atrial fibrillation; Electrocardiographic monitoring; Randomized controlled trial

Figure

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  Figure 1. Trial profile. Randomization, electrocardiography monitoring, follow-up, and participation in the extended follow-up. Four hundred and two patients were enrolled and randomized, four patients were randomized erroneously and were excluded from further analysis. Two hundred and seventy-four from 342 participants gave informed consent for extended follow-up. AF, atrial fibrillation.

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  Figure 2. Cumulative incidences of atrial fibrillation (AF) detection in the presence of the competing risk death. EPM, enhanced and prolonged monitoring.

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  Figure 3. Cumulative incidences of the combined endpoint of stroke and death (whatever occurs first). EPM, enhanced and prolonged monitoring.

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  Figure 4. Cumulative incidences of the combined endpoint of transient ischemic attack (TIA), stroke, and death (whatever occurs first). EPM, enhanced and prolonged monitoring.

Reference

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