Original ArticleNewly Diagnosed Atrial Fibrillation after Acute Ischemic Stroke and Transient Ischemic Attack: Importance of Immediate and Prolonged Continuous Cardiac Monitoring
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)
- et al.
Is ambulatory electrocardiography useful in the evaluation of patients with recent stroke?
Chest
(1995) - et al.
Recommendations for chamber quantification: A report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology
J Am Soc Echocardiogr
(2005) - et al.
Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: Population-based estimates
Am J Cardiol
(1998) - et al.
Intermittent atrial fibrillation may account for a large proportion of otherwise cryptogenic stroke: A study of 30-day cardiac event monitors
J Stroke Cerebrovasc Dis
(2009) - et al.
Atrial fibrillation after cardiac surgery: Risk factors and their temporal relationship in prophylactic drug strategy decision
Int J Cardiol
(2008) Long-term outcome after stroke due to atrial fibrillation
Cerebrovasc Dis
(2003)Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke
Lancet
(1993)- et al.
Newly diagnosed atrial fibrillation and acute stroke: The Framingham Study
Stroke
(1995) - et al.
Usefulness of ambulatory 7-day EKG monitoring for the detection of atrial fibrillation and flutter after acute stroke and transient ischemic attack
Stroke
(2004) - et al.
Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork (AFNET) and the European Heart Rhythm Association (EHRA)
Eur Heart J
(2007)
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
Multiple potential risks for stroke
JAMA
Infarcts of undetermined cause: The NINDS Stroke Data Bank
Ann Neurol
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