Atrial Fibrillation Detected By Prolonged ECG Monitoring In Acute Ischemic Stroke

BackgroundScreening of atrial fibrillation(AF)in patients with ischemic stroke is very important for etiological study,acute treatment,prognosis and secondary prevention of stroke.However,the detection rate of AF in patients with ischemic stroke in China is much lower than that in Europe and the United States.ObjectiveTo evaluate the detection rate of AF in patients with acute ischemic stroke,to find predictors of newly detected AF in patients with acute ischemic stroke,and to verify the value of STAF(score for the targeting of atrial fibrillation)and LADS(left atrial diameter,age,diagnosis of stroke or TIA,smoking)scores in screening patients with newly detected AF.MethodsPatients with acute ischemic stroke who had no history of AF in our hospital were enrolled.First,routine electrocardiogram and 24-hour dynamic electrocardiogram were used to screen AF.Patients with AF undetected were subjected to prolonged ECG monitoring for up to 14 days,using a single-lead ECG monitoring equipment.Predictors of newly-detected AF were determined by multivariate analysis.STAF and LADS scores were calculated and their applicabilities were determined by ROC curve.Results27 patients with acute ischemic stroke and without history of AF were enrolled(64.4 ±14.6 years old,81.5% males).Among them,2 patients(7.4%)had newlydetected AF through routine electrocardiogram or 24-hour dynamic electrocardiogram,and 3 patients(3/25,12%)were found AF on the 2nd,2nd and 3rd day,respectively.The overall new detection rate of AF reached 18.5%.The advanced age(OR= 1.125;95% CI,1.005-1.260)and elevated levels of homocysteine(OR= 1.319;95% CI,1.039-1.674),interleukin-6(OR= 1.246;95% CI,1.020-1.523)and D-dimer(OR= 5.652;95% CI,1.350-23.660)were associated with newly-detected AF.The best cut-off points of STAF and LADS scores were 4.5 and 3.5,respectively.The specificity and accuracy of STAF score was higher than that of LADS score.ConclusionThe application of single-lead device to prolong ECG monitoring significantly improved the detection rate of AF in patients with acute ischemic stroke.Advanced age and elevated levels of interleukin-6 and D-dimer may predict the detection of AF after stroke.