30-Day ECG Monitoring Ups A-Fib Detection After Stroke

Improved detection versus 24-hour monitoring in patients with ischemic stroke or TIA

30-Day ECG Monitoring Ups A-Fib Detection After Stroke

THURSDAY, June 26, 2014 (HealthDay News) -- For patients with ischemic stroke or transient ischemic attack, electrocardiogram (ECG) monitoring with a 30-day event-triggered recorder improves detection of atrial fibrillation, according to a study published June 26 in the New England Journal of Medicine.

David J. Gladstone, M.D., Ph.D., from the University of Toronto in Canada, and colleagues conducted a randomized trial to examine the presence of paroxysmal atrial fibrillation in patients with cryptogenic ischemic stroke or transient ischemic attack. A total of 572 patients, aged 55 years or older, without known atrial fibrillation, were randomized to undergo additional noninvasive ambulatory ECG monitoring with a 30-day event-triggered recorder (intervention group, 280 patients) or a conventional 24-hour monitor (control group, 277 patients).

The researchers detected atrial fibrillation lasting 30 seconds or longer in 16.1 percent of the intervention group and in 3.2 percent of the control group (P < 0.001; number needed to screen, eight). A total of 9.9 percent of the intervention group and 2.5 percent of the control group had atrial fibrillation lasting 2.5 minutes or longer (P < 0.001). Oral anticoagulant therapy had been prescribed for more patients in the intervention versus control group by 90 days (18.6 versus 11.1 percent; P = 0.01).

"Noninvasive ambulatory ECG monitoring for a target of 30 days significantly improved the detection of atrial fibrillation by a factor of more than five and nearly doubled the rate of anticoagulant treatment, as compared with the standard practice of short-duration ECG monitoring," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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