Detection of paroxysmal atrial fibrillation by prolonged electrocardiographic recording after ischaemic stroke in patients aged < 60 years: A study with 21-day recording using the SpiderFlash® monitor

• Published in: Archives of cardiovascular diseases 2015-03, Vol.108 (3), p.189-196
• Main Authors: Yayehd, Komlavi, Irles, Didier, Akret, Chrystelle, Vadot, Wilfried, Rodier, Gilles, Berremili, Toufek, Perenet, Sophie, Chevallier-Grenot, Marie, Belle, Loïc, Dompnier, Antoine
• Format: Article
• Language: English
• Subjects: Cardiovascular; Internal Medicine
• ISSN: 1875-2136
• DOI: 10.1016/j.acvd.2014.11.003

Summary Background Many studies have suggested that longer duration of cardiac monitoring is suitable for the detection of occult paroxysmal atrial fibrillation (AF) after stroke; however, most studies involved patients aged ≥ 65 years – a population with a high stroke rate. Aims To assess the incidence of paroxysmal AF in unselected young patients presenting with stroke. Methods We included consecutive patients aged < 60 years with a stroke diagnosis on magnetic resonance imaging. Aetiological screening included clinical history and examination, and biological and cardiac tests. Patients were included if they had no history of AF and if a 24-hour electrocardiogram recording detected no AF or atrial flutter. Patients wore the SpiderFlash® monitor for 21 days after discharge from hospital. The primary outcome was detection of paroxysmal AF episodes lasting > 30 seconds during monitoring. The secondary outcome was detection of paroxysmal AF episodes lasting < 30 seconds and any arrhythmia during monitoring. Results Among the 56 patients included (mean age 48 ± 9 years), 39 had cryptogenic stroke (CS) and 17 had stroke of known cause (SKC). Cardiac monitoring was achieved in 54 patients (37 CS, 17 SKC); one CS patient had a paroxysmal AF episode lasting > 30 seconds and one CS patient had a paroxysmal AF episode lasting < 30 seconds (versus no patients in the SKC group). Two CS patients and one SKC patient presented numerous premature atrial complexes. Non-sustained ventricular tachycardia was detected in one CS patient. Conclusion This prospective observational study showed a low rate of paroxysmal AF among young patients presenting with stroke, on the basis of 21-day cardiac monitoring. This result highlights the need to identify patients who would benefit from such long monitoring.