Post-stroke Holter-ECG findings beyond atrial fibrillation – A subgroup analysis of the MonDAFIS trial
N Thiessen, M C Olma, S Tuetuencue, M Jawad-Ul-Qamar, C Kunze, G Thomalla, D Nabavi, J Roether, U Laufs, R Veltkamp, P Heuschmann, P Kirchhof, M Endres, K G Haeusler, R SchnabelAbstract
Background/Introduction
Holter-ECG monitoring is routinely performed after a stroke or transient ischemic attack, mainly to detect atrial fibrillation. The incidence and potential relevance of unexpected abnormalities on Holter ECG has not been systematically assessed.
Purpose
Quantification of ECG abnormalities Holter-ECG recording after a stroke stratified by sex and age and determination of the effect of prolonged Holter ECG monitoring.
Methods
We used data from the prospective multicenter MonDAFIS trial, which randomized patients with acute ischemic stroke or transient ischemic attack (TIA) without known AF to Holter-ECG recording up to 7 days or usual care. Such 24-hour and 72-hour recordings were analyzed. ECG abnormalities were classified locally and reviewed by a dedicated core lab.
Results
Supraventricular tachycardia was detected in 68/1655 (4.1%) patients and newly-diagnosed AF in 36/1655 2.2% patients during 24-hour ECG monitoring. Occasional premature ventricular complexes were highly prevalent (85.8%), ventricular couplets (28.0%) or bigeminy (14.0%) less so. Non-sustained ventricular tachycardia was detected in 1.7% of patients. Extended 72-hour-monitoring in 1,283 patients detected supraventricular tachycardia in 113/1283 patients (8.8%) and AF in 39/1283 (3.0%) with higher detection rates across all abnormalities. Supraventricular arrhythmias were more frequently identified in women, while ventricular arrhythmias were more common in men.
Conclusion(s)
Post-stroke ECG monitoring detects a broad spectrum of arrhythmias beyond AF in a substantial proportion of patients. Prolonged monitoring and higher age are associated with increased diagnostic yield, with distinct sex-specific differences in arrhythmia patterns.Figure: Graphical Abstract