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. 2021 Apr;107(8):635-641.
doi: 10.1136/heartjnl-2020-316904. Epub 2020 Jul 3.

Continuous electrocardiography for detecting atrial fibrillation beyond 1 year after stroke in primary care

Louise Feldborg Lyckhage  1 , Morten Lock Hansen  2   3 , Jens Christian Toft  4 , Susanne Lis Larsen  5 , Bente Brendorp  6 , Ari Mohammad Ali  7 , Troels Wienecke  7   8
Affiliations

Continuous electrocardiography for detecting atrial fibrillation beyond 1 year after stroke in primary care

Louise Feldborg Lyckhage et al. Heart. 2021 Apr.

Abstract

Background and purpose: The diagnostic benefit of using continuous ECG (cECG) for poststroke atrial fibrillation (AF) screening in a primary care setting is unclear. We aimed to assess the diagnostic yield from screening patients who previously had a stroke with a 7-day Holter monitor.

Methods: Patients older than 49 years, naive to AF, with an ischaemic stroke over 1 year before enrolment were included. In a primary care setting, all patients were screened for AF using pulse palpation, 12-lead ECG and 7-day Holter monitoring. Further, NT-proBNP was determined at baseline.

Results: 7-day Holter monitoring uncovered AF in 17 of 366 patients (4.6% (95% CI 2.7 to 7.3)). The number needed to screen was 22 patients (14-37). 12-lead ECG uncovered AF in 3 patients (0.82% (95% CI 0.17 to 2.4)), and 122 patients had irregular pulse during pulse palpation (33.5% (95% CI 28.7 to 38.2)). When using 7-day Holter monitoring as reference standard, the sensitivity of pulse palpation and 12-lead ECG was 47% (95% CI 23% to 72%) and 18% (95% CI 4% to 43%). High levels (≥400 pg/mL) of NT-proBNP versus low levels (≤200 pg/mL) were not associated with AF in the univariate analysis nor when adjusted for age (OR 2.4 (95% CI 0.5 to 8.4) and 1.6 (95% CI 0.3 to 6.0)).

Conclusions: A relevant proportion of patients with stroke more than 1 year before inclusion were diagnosed with AF through 7-day Holter monitoring. Given the low sensitivities of pulse palpation and 12-lead ECG, additional cECG may be considered during poststroke primary care follow-up.

Keywords: atrial fibrillation; electrocardiography; primary care; stroke.

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Conflict of interest statement

Competing interests: LFL has competing interests as stated under the Funding section and personal fees from Bayer, outside the submitted work. TW reports personal fees from Boehringer Ingelheim and Bayer, outside the submitted work. MLH, JCT, SLL, BB and AMA have no disclosures.

Figures

Figure 1
Figure 1
Flow chart of patient selection and distribution between study locations. *Class I and III, digoxin, flecainide, and non-dihydropyridine calcium-channel blockers. GP clinic, general practice clinic; ICD, implantable cardioverter defibrillator; TIA, transient ischaemic attack.
Figure 2
Figure 2
Distribution of the total burden of AF during 7-day Holter monitoring in participants with ischaemic stroke more than 1 year before inclusion. Displayed with absolute values (A) and proportion of readable Holter ECG (B). AF, atrial fibrillation.
See this image and copyright information in PMC

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