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Subject Area

Orthopedic Surgery

Article Type

Original Study

Abstract

Objective To examine the feasibility of early use of 48-h Holter monitoring to detect the incidence of paroxysmal atrial fibrillation (AF) in patients presenting with acute stroke or transient ischemic attack (TIA) and without present evidence of AF in the Neurology Department (MUST University). Background Many ischemic stroke patients have undiagnosed paroxysmal AF. Paroxysmal AF diagnosis is relevant in individuals who present with cerebral stroke and without AF on admission. Diagnosis of paroxysmal AF is essential because it is a strong risk factor for stroke recurrence and also because oral anticoagulation has an advantage over antiplatelet treatment. Patients and methods The study included 200 consecutive patients who had acute ischemic stroke or TIA symptoms. Each of them had no evidence of AF at the time of presentation, and within 1 week, they performed Holter monitoring for 48 h. Results Two-hundred patients with mean age 65.27 ± 13.61 years old with TIA and acute ischemic stroke were found in 41 (20.5%) patients and 159 (79.5%) patients, respectively. All 200 patients were monitored by 48-h Holter. Among 200 cases, 13 (6.5%) patients had paroxysmal AF. All 13 patients had acute stroke and were older than age 60 years. It represented 8.17% of patients with acute cerebrovascular stroke (13 patients out of 159 patients with acute cerebrovascular stroke). The only factor related to an increased risk of paroxysmal AF was stroke type. AF was responsible for 50% of clinically suspected cardiac embolic stroke cases. Conclusion Paroxysmal AF was diagnosed in ~ 6.5% of acute-stroke or TIA patients having normal ECG rhythm by early use of 48-h Holter monitoring. In acute cerebrovascular stroke patients, AF represented 8.17%. Holter monitoring is a feasible and simple tool for paroxysmal AF diagnosis in TIA or acute-stroke patients, thus allowing proper treatment and better secondary prevention.

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