Original Article
Newly Diagnosed Atrial Fibrillation after Acute Ischemic Stroke and Transient Ischemic Attack: Importance of Immediate and Prolonged Continuous Cardiac Monitoring

https://doi.org/10.1016/j.jstrokecerebrovasdis.2010.06.010Get rights and content

Atrial fibrillation (AF) is the major cause of cardioembolic stroke. It often remains occult when asymptomatic and paroxysmal. We hypothesized that the detection of AF after acute ischemic stroke (AIS) or transient ischemic attack (TIA) could be improved by using continuous cardiac monitoring (CCM) immediately after admission. We sought to determine the detection rate of AF by immediate in-hospital CCM after cryptogenic and noncryptogenic AIS or TIA in patients without a previous diagnosis of AF. We retrospectively studied a cohort of 155 patients with cryptogenic and noncryptogenic AIS or TIA without known AF. We compared the detection rates of newly diagnosed AF (NDAF) in patients admitted to areas with CCM and those never admitted to these areas. We developed a multiple logistic regression model for identifying predictors of NDAF. We characterized NDAF episodes and analyzed how the availability of CCM data changed secondary prevention strategies. We detected NDAF in 21 patients (13.5%). Diagnostic rates of NDAF in patients who underwent CCM and those who did not undergo CCM were 18.2% and 2.2%, respectively (P = .005). The median time from admission to recognition of NDAF was 2.0 days. Most NDAFs were paroxysmal (95.2%) and lasted less than 1 hour (85.7%). Diabetes mellitus and infarct size were predictors of NDAF. Detection of NDAF prompted the initiation of anticoagulation therapy in 8.2% of the patients admitted to areas with CCM availability. Our findings suggest that immediate and prolonged CCM significantly improves the detection of NDAF after cryptogenic and noncryptogenic AIS or TIA, and that diabetes mellitus and infarct size are significantly associated with NDAF.

Section snippets

Methods

This retrospective case series included all consecutive patients aged >18 years admitted to our hospital with a diagnosis of AIS or TIA between January 1, 2007, and December 31, 2008. Our study cohort comprised both cryptogenic and noncryptogenic events. We chose to study noncryptogenic AIS and TIAs because more than one pathophysiologic mechanism can coexist in the same patient (eg, extracranial carotid disease and AF) [8]. Thus, even patients with a defined noncardioembolic stroke could

Results

A total of 198 patients with AIS or TIA were admitted to our institution during the study period (Fig 1). The study population comprised 155 patients (114 with AIS and 41 with TIA) after the exclusion of 26 patients with chronic AF (13.1%), 14 with paroxysmal AF (7.1%), and 3 with AF detected on the admission ECG (1.5%). A total of 113 patients were admitted to at least one CCA (91 to the telemetry ward, 30 to the ICU, 19 to the CCU, and 29 to the postsurgical care unit), and 45 patients were

Discussion

We found that NDAF is common in patients with cryptogenic and noncryptogenic AIS or TIA undergoing immediate and prolonged in-hospital CCM. The rate of NDAF was higher in patients undergoing CCM at a CCA compared with those assessed by ECG outside of a CCA. Most episodes of NDAF were recognized during the first 3 days of hospitalization. Diabetes mellitus and infarct size were independent predictors of NDAF. Identification of the arrhythmia led to important changes in interpretation of the

Acknowledgment

We thank Professors Branco Mautner and Gerardo Bozovich for their critical review of the manuscript and Drs Analía Calle, Noelia Pontello, and Francisco Muñoz Giacomelli for data collection.

References (27)

  • C. Piorkowski et al.

    Value of different follow-up strategies to assess the efficacy of circumferential pulmonary vein ablation for the curative treatment of atrial fibrillation

    J Cardiovasc Electrophysiol

    (2005)
  • L.R. Caplan

    Multiple potential risks for stroke

    JAMA

    (2000)
  • R.L. Sacco et al.

    Infarcts of undetermined cause: The NINDS Stroke Data Bank

    Ann Neurol

    (1989)
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