Cryptogenic Acute Ischemic Stroke: Assessment of the Performance of a New Continuous Long-Term Monitoring System in the Detection of Atrial Fibrillation

Sampaio, Rogerio Ferreira; Gomes, Isabel Cristina; Sternick, Eduardo Back

doi:10.5935/abc.20180112

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Original Article • Arq. Bras. Cardiol. 111 (2) • Aug 2018 • https://doi.org/10.5935/abc.20180112 copy

Cryptogenic Acute Ischemic Stroke: Assessment of the Performance of a New Continuous Long-Term Monitoring System in the Detection of Atrial Fibrillation

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Long-term monitoring has been advocated to enhance the detection of atrial fibrillation (AF) in patients with stroke.

Objective:

To evaluate the performance of a new ambulatory monitoring system with mobile data transmission (PoIP) compared with 24-hour Holter. We also aimed to evaluate the incidence of arrhythmias in patients with and without stroke or transient ischemic attack.

Methods:

Consecutive patients with and without stroke or TIA, without AF, were matched by propensity score. Participants underwent 24-hour Holter and 7-day PoIP monitoring.

Results:

We selected 52 of 84 patients (26 with stroke or TIA and 26 controls). Connection and recording times were 156.5 ± 22.5 and 148.8 ± 20.8 hours, with a signal loss of 6,8% and 11,4%, respectively. Connection time was longer in ambulatory (164.3 ± 15.8 h) than in hospitalized patients (148.8 ± 25.6 h) (p = 0.02), while recording time did not differ between them (153.7 ± 16.9 and 143.0 ± 23.3 h). AF episodes were detected in 1 patient with stroke by Holter, and in 7 individuals (1 control and 6 strokes) by PoIP. There was no difference in the incidence of arrhythmias between the groups.

Conclusions:

Holter and PoIP performed equally well in the first 24 hours. Data transmission loss (4.5%) occurred by a mismatch between signal transmission (2.5G) and signal reception (3G) protocols in cell phone towers (3G). The incidence of arrhythmias was not different between stroke/TIA and control groups.

Keywords:
Atrial Fibrillation; Stroke; Electrocardiography, Ambulatory; Cell Phone; Ischemic Attack, Transient

Variables	Sample (n = 52)	stroke/TIA (n = 26)	Controls (n = 26)	P-value
Clinical data
Male sex	27 (51.9%)	14 (53.8%)	13 (50%)	1.000^Q
Age (years)	70.7 ± 10.5	70.9 ± 11.4	70.6 ± 9.7	0.917^T
≥ 65 years	38 (73.1%)	20 (76.9%)	18 (69.2%)	0.755^Q
White race	40 (76.9%)	17 (65.4%)	23 (88.5%)	0.100^F
BMI (kg/m²)	25.5 ± 5.6	25.6 ± 4.2	25.4 ± 6.9	0.498^W
> 30 kg/m²	11 (21.2%)	3 (11.5%)	8 (30.8%)	0.173^F
Smoking	11 (21.2%)	9 (34.6%)	2 (7.7%)	0.038^F
< 65 years	3 (21.4%)	2 (33.3%)	1 (12.5%)	0.539^F
≥ 65 years	8 (21.1%)	7 (35%)	1 (5.6%)	0.045^F
Alcohol consumption	10 (19.2%)	7 (26.9%)	3 (11.5%)	0.291^F
Corrected CHADS₂	1.8 ± 0.9	1.8 ± 1	1.9 ± 0.8	0.831^W
Corrected CHA₂DS₂-VASc	3.3 ± 1.2	3.3 ± 1.3	3.3 ± 1.2	0.598^W
Comorbidities
Arterial hypertension	44 (84.6%)	23 (88.5%)	21 (80.8%)	0.703^F
Diabetes mellitus	27 (51.9%)	13 (50%)	14 (53.8%)	1.000^F
Previous stroke²	6 (11.5%)	6 (23.1%)	-
Previous TIA²	6 (11.5%)	6 (23.1%)	-
Coronary insufficiency	5 (9.6%)	2 (7.7%)	3 (11.5%)	1.000^F
Congestive heart failure	5 (9.6%)	3 (11.5%)	2 (7.7%)	1.000^F
Kidney failure	2 (3.8%)	2 (7.7%)	-
Echocardiography
Aorta (mm)	32.6 ± 3.9	33.6 ± 4.3	31.6 ± 3.3	0.079^T
Left atrium (mm)	36.9 ± 4.5	36.3 ± 4	37.6 ± 4.9	0.296^T
Ejection fraction (%)	63.6 ± 10.3	61 ± 11.3	66 ± 8.9	0.049^W
Interventricular septum (mm)	10.3 ± 1.4	10.7 ± 1.4	10 ± 1.3	0.086^W
RV posterior wall (mm)	9.9 ± 1.3	10.1 ± 1.4	9.8 ± 1.3	0.356^W
Laboratory data
Glucose (mg/dl)	113 ± 57.5	125.5 ± 76.6	100.5 ± 23.5	0.098^W
Glycated hemoglobin (%)	6.1 ± 0.7	6.1 ± 0.8	6.1 ± 0.7	0.848^T
Creatinine (mg/dl)	1.01 ± 0.38	1.06 ± 0.44	0.96 ± 0.31	0.614^W
HDL (mg/dl)	53.1 ± 15.7	48.8 ± 11.8	57.1 ± 18.1	0.059^T
LDL (mg/dl)	87.2 ± 30.8	91.1 ± 33.8	83.3 ± 27.7	0.376^T
Triglycerides (mg/dl)	142.8 ± 96.3	112.4 ± 42.9	171.9 ± 122.4	0.060^W
TSH (nU/L)	3 ± 3.21	2.70 ± 2.39	3.22 ± 3.82	0.459^W
Free T4 (ng/dl)	1.03 ± 0.23	1.10 ± 0.25	0.96 ± 0.20	0.038^T

Variables	Sample (n = 52)	Stroke/TIA (n = 26)	Controls (n = 26)	P-value
Holter
Recording time	23.5 ± 0.6	23.4 ± 0.8	23.5 ± 0.4	0.948
Loss (artifacts)	0.6 ± 1.4	0.6 ± 1.7	0.6 ± 1	0.162
PoIP
Connection period	156.5 ± 22.5	148.8 ± 25.6	164.3 ± 15.8	0.024
Recording time on the first day	19.2 ± 3.4	19.1 ± 2.5	19.2 ± 4.2	0.514
Recording period	148.8 ± 20.8	143.9 ± 23.3	153.7 ± 16.9	0.080
Loss (artifacts)	50.9 ± 26.2	45.6 ± 26.3	56.1 ± 25.5	0.081

Variables	Stroke/TIA (n = 26)	Controls (n = 26)	p-value^F F Fisher’s exact test;
Atrial fibrillation (< 30 seconds)	1 (3.8%)	-	-
Atrial tachycardia (AT)	16 (61.5%)	9 (34.6%)	0.095
< 65 years	1 (16.7%)	2 (25%)	1.000
≥ 65 years	15 (75%)	7 (38.9%)	0.047
*Frequent SVES^ * frequent SVES was defined as > de 30 events/hour**
< 65 years	5 (19.2%)	3 (11.5%)	0.703
≥ 65 years	5 (25%)	3 (16.7%)	0.697
Frequent AT or SVES	17 (65.4%)	10 (38.5%)	0.095
< 65 years	1 (16.7%)	2 (25%)	1.000
≥ 65 years	16 (80%)	8 (44.4%)	0.042
Ventricular tachycardia	6 (23.1%)	5 (19.2%)	1.000
< 65 years	-	1 (12.5%)	-
≥ 65 years	6 (30%)	4 (22.2%)	0.719
Frequent SVES	6 (23.1%)	7 (26.9%)	1.000
< 65 years	-	1 (12.5%)	-
≥ 65 years	6 (30%)	6 (33.3%)	1.000

Variables	Stroke/TIA (n = 26)	Controls (n = 26)	p-value^F F Fisher’s exact test;
*Atrial fibrillation (< 30 seconds)^ * all cases identified in patients aged ≥65 years;**	6 (23.1%)	1 (3.8%)	0.099
First 24h	2 (7.7%)	1 (3.8%)	1.000
Atrial tachycardia	22 (84.6%)	18 (69.2%)	0.324
< 65 years	4 (66.7%)	5 (62.5%)	1.000
≥ 65 years	18 (90%)	13 (72.2%)	0.222
First 24h	12 (46.2%)	14 (53.8%)	0.782
Frequent SVES^ frequent SVES was defined as > de 30 events/hour	4 (15.4%)	6 (23.1%)	0.727
< 65 years	-	1 (12.5%)	-
≥ 65 years	4 (20%)	5 (27.8%)	0.709
First 24h	2 (7.7%)	6 (23.1%)	0.249
Frequent atrial tachycardia or SVES	22 (84.6%)	19 (73.1%)	0.499
< 65 years	4 (66.7%)	5 (62.5%)	1.000
≥ 65 years	18 (90%)	14 (77.8%)	0.395
First 24h	12 (46.2%)	14 (53.8%)	0.782
Ventricular tachycardia	7 (26.9%)	7 (26.9%)	1.000
< 65 years	-	2 (25%)	-
≥ 65 years	7 (35%)	5 (27.8%)	0.734
First 24h	3 (11.5%)	4 (15.4%)	1.000
Frequent ventricular extrasystoles	8 (30.8%)	7 (26.9%)	1.000
< 65 years	1 (16.7%)	1 (12.5%)	1.000
≥ 65 years	7 (35%)	6 (33.3%)	1.000
First 24h	6 (23.1%)	6 (23.1%)	1.000

Variable	Holter	POIP	p-value^F F Fisher’s exact test;
Atrial fibrillation (< 30 seconds)	1 (1.9%)	7 (13.5%)	0.060
AVC/AIT	1 (3.8%)	6 (23.1%)	0.099
Controls	-	1 (3.8%)	-
First 24h	1 (1.9%)	3 (5.7%)	0.618
Atrial tachycardia	25 (48.1%)	40 (76.9%)	0.004
AVC/AIT	16 (61.5%)	22 (84.6%)	0.116
Controls	9 (34.6%)	18 (69.2%)	0.025
First 24h	25 (48.1%)	26 (50%)	1.000
*Frequent SVES^ * frequent SVES was defined as > de 30 events/hour**	8 (15.4%)	10 (19.2%)	0.796
AVC/AIT	5 (19.2%)	4 (15.4%)	1.000
Controls	3 (11.5%)	6 (23.1%)	0.465
First 24h	8 (15.4%)	8 (15.4%)	1.000
Frequent atrial tachycardia or SVES	27 (51.9%)	41 (78.8%)	0.007
Stroke/TIA	17 (65.4%)	22 (84.6%)	0.199
Controls	10 (38.5%)	19 (73.1%)	0.025
First 24h	27 (51.9%)	26 (50%)	1.000
Ventricular tachycardia	11 (21.2%)	14 (26.9%)	0.647
Stroke/TIA	6 (23.1%)	7 (26.9%)	1.000
Controls	5 (19.2%)	7 (26.9%)	0.743
First 24h	11 (21.2%)	7 (13.5%)	0.438
Frequent ventricular extrasystoles	13 (25%)	15 (28.8%)	0.825
Stroke/TIA	6 (23.1%)	8 (30.8%)	0.755
Controls	7 (26.9%)	7 (26.9%)	1.000
First 24h	13 (25%)	12 (23.1%)	1.000

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