IS 24 HOUR ECG MONITORING THE INVESTIGATION OF CHOICE TO DIAGNOSE PAROXYSMAL ATRIAL FIBRILLATION?
Background and Aims
Atrial fibrillation (AF) is the most common sustained adult cardiac arrhythmia causing ischaemic strokes. Paroxysmal AF (PAF) is undetected and untreated if sufficient ECG monitoring is not performed adequately. Adequate diagnosis of AF following an ischaemic stroke is vital in preventing further strokes. Current guidelines recommend a minimum of 24 hours ECG monitoring after a stroke to exclude PAF. We want to study if this recommendation is reliable in diagnosing PAF.
In this retrospective study, we investigated the detection rate of PAF with prolonged ECG monitoring in 100 stroke patients admitted over 6 months to Worcester Royal Hospital. Data was collected using patient notes and standards were set against the Royal College of Physicians Stroke Guidelines UK.
This study included ninety-seven 24-hour tapes, two 72-hour tapes and one 7-day tape. Among 100 eligible stroke patients, 9 (9%) patients were found to have PAF from 24-hour ECG monitoring. 3 out of 5 known AF patients showed AF in 24 hour monitoring which were excluded from the total of 9 identified AFs. 6 AFs were newly diagnosed which gives a pick up rate of 6.52%.The two 72-hour and the 7-day tape in the study did not pick up AF in the presenting stroke patients.
Prolonged ECG monitoring for more than 24-hours duration is required in order to maximise the diagnosis of PAF. Optimal duration of ECG monitoring should be further investigated.