Abstract
Background and purposeThe rate of newly detected (paroxysmal) atrial fibrillation (AF) during inpatient cardiac telemetry is low. The objective of this study was to evaluate the additional diagnostic yield of an automated detection algorithm for AF on telemetric monitoring compared with routine detection by a stroke unit team in patients with recent ischemic stroke or TIA. MethodsPatients admitted to the stroke unit of Medisch Spectrum Twente with acute ischemic stroke or TIA and no history of AF were prospectively included. All patients had telemetry monitoring, routinely assessed by the stroke unit team. The ST segment and arrhythmia monitoring (ST/AR) algorithm was active, with deactivated AF alarms. After 24 h the detections were analyzed and compared with routine evaluation. ResultsFive hundred and seven patients were included (52.5% male, mean age 70.2 ± 12.9 years). Median monitor duration was 24 (interquartile range 22–27) h. In 6 patients (1.2%) routine analysis by the stroke unit team concluded AF. In 24 patients (4.7%), the ST/AR Algorithm suggested AF. Interrater reliability was low (κ, 0.388, p < 0.001). Suggested AF by the algorithm turned out to be false positive in 11 patients. In 13 patients (2.6%) AF was correctly diagnosed by the algorithm. None of the cases detected by routine analysis were missed by the algorithm. ConclusionsAutomated AF detection during 24-h telemetry in ischemic stroke patients is of additional value to detect paroxysmal AF compared with routine analysis by the stroke unit team alone. Automated detections need to be carefully evaluated.
Highlights
Stroke severity was assessed with the NIH Stroke Scale and the cause of stroke was classified according to the Trial of ORG 10172 in Acute Stroke (TOAST) classification.[15]
Diagnosed with ischemic stroke or TIA, 141 patients had a history of Atrial fibrillation (AF) (19.4%), and 33 patients were newly diagnosed with AF based on admission ECG (4.5%)
We found that the use of a telemetry algorithm for detection of AF led to a more than 2-fold increase of detection rate compared with routine stroke unit team evaluation
Summary
The 2018 AHA/ASA stroke guideline recommends heart rhythm monitoring for at least 24 h after stroke.[3]. AF detection rates are low since AF is often transient and frequently asymptomatic.[1,2] A meta-analysis showed a rate of newly detected AF in 4.1% of 2783 patients during continuous inpatient cardiac telemetry.[9] The low detection rate might be due to missed AF episodes by insufficient trained staff, unattended time periods or the absence of automated detection algorithms. Several studies have evaluated different strategies for inhospital heart rhythm monitoring with contradicting results.10À13 no specific real-time monitor-algorithm for the detection of AF was used. The objective of this study was to evaluate the additional diagnostic yield of an automated detection algorithm for AF on telemetric monitoring compared with routine detection by a stroke unit team in patients with recent ischemic stroke or TIA. All patients had telemetry monitoring, routinely assessed by the stroke unit team.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
