Supervisors info:
Βασιλοπούλου Σοφία, Επίκουρη Καθηγήτρια, Ιατρική σχολή, ΕΚΠΑ
Κορομπόκη Ελένη, Παθολόγος επιμελήτρια Β, Θεραπευτική κλινική ΓΝΑ Αλεξανδρα, ΕΚΠΑ
Κραββαρίτη Ευρυδικη, Παθολόγος, Ακαδημαϊκή Υπότροφος, Ιατρική σχολή, ΕΚΠΑ
Summary:
Strokes are considered as one of the major causes of disability and deaths worldwide and their incidence increases with age. Despite the significant progress in strokes’ diagnostic procedures there is about 20%-25% of them lacking possible cause. In these cases, atrial fibrillation is considered as the probable cause which is often undetected because characteristics such as short duration, episodic, and frequently asymptomatic nature make it challenging to diagnose.
Current guidelines recommend that 24-hour Holter monitoring is used to detect PAF when suspected, and no other cause for TIA or stroke is found. However, the optimum timing after stroke, duration, method of monitoring and setting (outpatient or inpatient), to maximize the detection of PAF after stroke/ TIA are unclear, specially for pοpulation above 60 years old.
We performed a meta-analysis which included 8 randomized controlled trials and prospective observational studies that enrolled 3270 ischemic stroke or TIA patients aged ≥ 60, with no history of AF during screening, who underwent a cardiac monitoring method (invasive or non-invasive) for at least 12 hours for the detection of AF episodes lasting ≥ 30 sec.
The overall rate of newly detected AF in ischemic stroke or TIA patients was 9,52% (95% CI: 7,01%- 12,03%). The AF detection rates in subgroups relative with monitoring duration time was 4,67% (95% CI: 2,07%- 7,27%) (≤ 24 hours), 10,56% (95% CI: 7,16%- 13,95%) (48hours- 7 days), and 16,53% (95% CI: 9,24%- 23,83%) (≥7days).
In conclusion, in case of monitoring time ≤ 24hours detection rate was statistically significant smaller comparing with the other two groups while the rate is increased by the increase of the monitoring time. Prospective studies are needed to determine the “Gold standard” diagnostic procedure for AF detection in the elderly population after stroke.
Keywords:
Atrial fibrillation, Cardiac monitoring, Stroke, Age > 60
