Abstract TP282: Clinical Predictors To Identify Paroxysmal Atrial Fibrillation After Ischemic Stroke

Abstract

Introduction: Detection of paroxysmal atrial fibrillation (PAF) after an ischemic cerebrovascular event is of imminent interest, because oral anticoagulation as a highly effective secondary preventive treatment is available. Whereas permanent atrial fibrillation (AF) can be detected during routine electrocardiogram (ECG), longer detection duration will detect more PAF but might be resource consuming. Methods: Patients with acute ischemic stroke were prospectively investigated with an intensified algorithm to detect PAF (7 day Holter ECG, follow-up investigations after 90 days and one year, ISRCTN 46104198). Results: 281 patients were prospectively included in the study, 44 of which had to be excluded since they presented with permanent AF as diagnosed by ECG during admission and another 13 patients due other causes leaving 224 patients (mean age: 68.5 years, 58.5% male) as the final study population. 29 (12.9%) patients could be identified to have PAF during prolonged (median: 6.7 days IQR: 4.4-7.0) Holter monitoring, an additional 8 (3.6%) and 5 (2.2%) patients after follow-up investigations after 90 days and 1 year, respectively. In 182 patients no AF could be detected. Multivariate analysis identified advanced age (Odds ratio (OR) 1.04, 95% confidence interval (CI): 1.01-1.08), a higher initial NIH-SS (OR 1.10, 95% CI: 1.00-1.21) as well as clinical symptoms >24h (OR 3.45, 95% CI: 1.06-11.19) and a history of coronary artery disease (OR 2.74, 95% CI: 1.16-6.50) to be predictive for the detection of PAF. Receiver operation characteristics demonstrated an area under the curve of 0.783 for this model. Neither the results of blood analysis, duplex sonography, cerebral imaging nor routine echocardiography could be found to be independently associated with the detection of PAF. Conclusion: In acute stroke patients with advanced age, history of coronary artery disease, higher NIH-SS scores and ischemic stroke as the presenting event, a prolonged Holter ECG monitoring and follow-up is warranted to identify PAF. This could increase the detection rate of patients requiring anticoagulation and would be expected to reduce the risk of recurrent stroke in case of consequent anticoagulation of these patients.