Abstract
Background
The etiology of cerebral ischemia is undetermined in one-third of patients upon discharge.
Occult paroxysmal atrial fibrillation (PAF) is considered a potential etiology. A
high rate of PAF detection with 21-day mobile cardiac outpatient telemetry (MCOT)
has been reported in two small studies. Optimal monitoring duration and factors predicting
PAF have not been adequately defined.
Methods
We performed a retrospective analysis on patients evaluated by MCOT monitoring within
6 months of a cryptogenic stroke or TIA. Multivariate analysis with survival regression
methods was performed using baseline characteristics to determine predictive risk
factors for detection of PAF. Kaplan–Meier estimates were computed for 21-day PAF
rates.
Results
We analyzed 156 records; PAF occurred in 27 of 156 (17.3%) patients during MCOT monitoring
of up to 30 days. The rate of PAF detection significantly increased from 3.9% in the initial 48 h, to 9.2% at 7 days, 15.1% at 14 days, and 19.5% by 21 days (p<0.05). Female gender, premature atrial complex on ECG, increased left atrial diameter,
reduced left ventricular ejection fraction and greater stroke severity were independent
predictors of PAF detection on multivariate analysis with strongest correlation seen
for premature atrial complex on ECG (HR 13.7, p=0.001).
Conclusion
MCOT frequently detects PAF in patients with cryptogenic stroke and TIA. Length of
monitoring is strongly associated with detection of PAF, with an optimal monitoring
period of at least 21 days. Of the predictors of PAF detection, the presence of premature atrial complexes
on ECG held the strongest correlation with PAF.
Keywords
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Article info
Publication history
Published online: October 24, 2012
Accepted:
October 4,
2012
Received in revised form:
September 11,
2012
Received:
July 19,
2012
Identification
Copyright
Published by Elsevier Inc.
