Value of Holter monitoring in patients with cardioembolic stroke

• Type: Summary of Presentation in an International Conference
• Date: 2012

Authors

Sousa C (Author) Other; Rema J (Author) Other; Sousa A (Author) Other; Paiva M (Author) Other; Lebreiro A (Author) Other; Rangel I (Author) Other; Souteiro D (Author) Other; Chaves P (Author) Other; Campelo M (Author) Other; Maciel MJ (Author) FMUP

Conference proceedings International

Title: European Journal of Heart Failure Supplements

Initial page: S73

Heart Failure Congress 2012

Belgrade, 2012

Scientific classification

FOS: Medical and Health sciences > Clinical medicine

Other information

Abstract (EN): Background: Cardioembolic stroke accounts for 14-30% of all cerebral infarctions and atrial fibrillation (AF) is the most important cause. Recurrence of cardioembolism can be prevented by oral anticoagulation. Therefore, identification of paroxysmal atrial fibrillation (PAF) may have crucial prognostic impact. Holter monitoring (HM) has been increasingly used in stroke and transient ischemic attack (TIA) patients as a routine investigation to search for occult PAF. The purpose of this study was to quantify the diagnostic yield of 24-hour HM for detection of PAF in patients after stroke or TIA. Methods: HM exams performed between October 2009 and October 2011 were reviewed. 108 examinations made in the setting of post stroke or TIA in sinus rhythm patients were identified and analyzed. Clinical, echocardiographic and neuroimaging data were collected. Patients with PAF were compared to those without PAF. Additionally, supraventricular arrhythmic profile was evaluated in patients in sinus rhythm. Results: In our population 52.4% were male, with a mean age of 64.1±14.8 years. Eighty six patients (80.2%) had a stroke (41.1% PACI), and 22 (19.8%) a TIA. HM had a mean duration of 22.8±3.3 hours. PAF occurred in 3.6% of the patients (4), all older than age 55 and all with previous stroke. PAF lasting more than 30 seconds was evident in 1.8% of the patients (2). The rest (2 patients), had PAF lasting less than 30 seconds. Patients with PAF were compared to the sinus rhythm ones and no statistically significant differences were found, either concerning to clinical or to imaging data (including left atrium size and infarct locationin the CT-scan in those with stroke). In the sinus rhythm group, excessive supraventricular ectopic activity (ESVEA) (≥ 30 premature supraventricular beats per hour or any episode with runs of ≥ 20 premature supraventricular beats) was present in 5.6% of the patients (6), all older than 55 years. These patients were no different from those without ESVEA - no correlation was found between evaluated HM, clinical and imaging variables. Conclusions: Holter monitoring permitted the recognition of unknown PAF episodes in 3.6% of the patients with definite stroke or TIA. Additionally, it allowed the identification of ESVEA, a newly established stroke risk factor, in 5.6% of the cases. Holter monitoring proved to remain a valuable tool in the work up of suspected cardioembolic stroke. New strategies to increase PAF detection rates are needed.

Language: English

Type (Professor's evaluation): Scientific

Notes: Sousa C, Rema J, Sousa A, Paiva M, Lebreiro A, Rangel I, Souteiro D, Chaves P, Campelo M, Maciel MJ. Value of Holter monitoring in patients with cardioembolic stroke. Eur J Heart Fail Suppl 2012; 11(Suppl 1): P449. ISSN 1567-4215. Heart Failure Congress 2012, Belgrade, 2012