Atrial fibrillation trial to evaluate real-world procedures for their utility in helping to lower stroke events: A randomized clinical trial
Journal
International Journal of Stroke
Journal Volume
16
Journal Issue
3
Pages
300-310
Date Issued
2021
Author(s)
Huang W.-Y.
Lee M.
Sung S.-F.
Chang K.-H.
Huang Y.-S.
Lee J.-D.
Lee T.-H.
Chung C.-M.
Wu Y.-L.
Hsieh T.-T.
Ovbiagele B.
Abstract
Background: Enhancing detection of unrecognized atrial fibrillation among acute ischemic stroke patients is crucial for secondary stroke prevention. Aim: To evaluate whether the detection rate of new atrial fibrillation in acute ischemic stroke patients without known atrial fibrillation could be improved by doing serial 12-lead electrocardiograms once daily for five days, compared with conventional 24-h Holter monitoring (24-h Holter). Methods: We conducted a randomized clinical trial to compare the detection rates of paroxysmal atrial fibrillation between serial electrocardiograms versus 24-h Holter from October 2015 to October 2018 at six hospitals. Eligible participants were acute ischemic stroke patients with aged ?65 years, with neither atrial fibrillation history nor any presence of atrial fibrillation on baseline electrocardiogram at admission. The primary outcome was newly detected electrocardiogram in the serial electrocardiograms and 24-h Holter group. Results: Among 826 patients, baseline characteristics were similar between both groups. In the intention-to-treat analysis, there was no statistical difference between serial electrocardiograms versus 24-Holter to detect atrial fibrillation (8.4% vs. 6.9%; adjusted odds ratio 1.17, 95% confidence interval 0.69–2.01). Stepwise multivariate logistic regression revealed age ?80 years and history of heart failure were associated with detection of paroxysmal atrial fibrillation whereas patients with lacunar infarction had lower odds for detection of paroxysmal atrial fibrillation. Conclusions: Serial electrocardiograms had comparable detection rate of paroxysmal atrial fibrillation compared with 24-h Holter and might be a viable alternative to 24-h Holter as a first-line approach to survey for potential paroxysmal atrial fibrillation among elderly patients with acute ischemic stroke. Clinical Trial Registration: URL https://clinicaltrials.gov/ct2/show/NCT02578979 Unique Identifiers: NCT02578979 ? 2020 World Stroke Organization.
SDGs
Other Subjects
acute ischemic stroke; adult; age; Article; comparative study; controlled study; electrocardiogram; female; health care utilization; heart failure; Holter monitoring; human; lacunar stroke; major clinical study; male; medical history; paroxysmal atrial fibrillation; randomized controlled trial; transient ischemic attack; aged; ambulatory electrocardiography; atrial fibrillation; brain ischemia; cerebrovascular accident; complication; electrocardiography; very elderly; Aged; Aged, 80 and over; Atrial Fibrillation; Brain Ischemia; Electrocardiography; Electrocardiography, Ambulatory; Humans; Stroke
Type
journal article