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Use of Ambulatory Electrocardiography for the Detection of Paroxysmal Atrial Fibrillation in Patients with Stroke

Published online by Cambridge University Press:  04 August 2016

Chaim Bell ,
Moira Kapral  and
The Canadian Task Force on Preventive Health Care
Chaim Bell*
Affiliation:
Department of Medicine, University of Toronto, Institute of Medical Science, Program in Clinical Epidemiology and Health Services Research
Moira Kapral
Affiliation:
Department of Medicine, University of Toronto, Division of General Internal Medicine and Clinical Epidemiology, University Health Network, Toronto, Canada and the Institute for Clinical and Evaluative Sciences
*
Task Force on Preventive Health Care, 801 Commissioners Rd. East, London, Ontario, N6C 5J1
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Abstract:

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Background:

Patients with stroke commonly undergo investigations to determine the underlying cause of stroke. These investigations often include ambulatory electrocardiography to detect paroxysmal atrial fibrillation. There is conflicting evidence in the literature regarding whether routine ambulatory electrocardiography should be performed in all or selected stroke patients. This paper reviews the available evidence on (1) the yield of ambulatory electrocardiography in detecting paroxysmal atrial fibrillation in patients with stroke or transient ischemic attack and (2) the effectiveness of anticoagulation in preventing recurrent stroke in patients with paroxysmal atrial fibrillation.

Methods:

A MEDLINE search for primary articles was performed, and the references were reviewed manually. In addition, citations were obtained from experts. The evidence was systematically reviewed using the evidence-based methodology of the Canadian Task Force on Preventive Health Care.

Results:

Ambulatory electrocardiography can detect atrial fibrillation not found on initial electrocardiogram in between 1% and 5 % of people with stroke. Ambulatory electrocardiography is generally safe. The risk of recurrent stroke in the setting of paroxysmal atrial fibrillation is uncertain, but appears to be similar to that seen with chronic atrial fibrillation (about 12% per year). Therapy with warfarin may reduce this risk by about two-thirds as compared to placebo. The annual risk of major bleeding with warfarin therapy is between 1% and 3% but rates for individual patients depend on various specific risk factors.

Interpretation:

There is insufficient evidence to recommend for or against the use of ambulatory electrocardiography for the detection of paroxysmal atrial fibrillation in either selected or unselected patients with stroke (C Recommendation). There is fair evidence to recommend therapy with warfarin for patients with stroke and paroxysmal atrial fibrillation (B Recommendation).

Résumé:

RÉSUMÉ:Introduction:

Les patients ayant subi un AVC sont couramment investigués pour déterminer la cause de l'AVC. Ces investigations incluent souvent un enregistrement électrocardiographique ambulatoire pour détecter une fibrillation auriculaire paroxystique. Il existe des données conflictuelles dans la littérature concernant l'utilisation de routine de l'électrocardiographie ambulatoire chez tous les patients ayant subi un AVC ou chez des cas particuliers. Nous revoyons les données disponibles sur 1) le taux de détection de la fibrillation auriculaire paroxystique par électrocardiographie ambulatoire chez les patients ayant subi un AVC ou une ischémie transitoire et 2) l'efficacité de l'anticoagulation dans la prévention d'une récidive de l'AVC chez les patients qui ont une fibrillation auriculaire paroxystique.

Méthodes:

Une recherche d'articles dont c'était le sujet principal dans MEDLINE a été effectuée et les références ont été révisées manuellement. De plus, l'opinion d'experts dans le domaine a été obtenue. Les observations ont été révisées systématiquement en utilisant la méthodologie basée sur des données probantes du Groupe de travail Canadien sur les soins de santé préventifs.

Résultats:

L'électrocardiographie ambulatoire peut détecter une fibrillation auriculaire qui n'a pas été détectée à l'électrocardiogramme initial chez 1% à 5% des patients ayant subi un AVC. L'électrocardiographie ambulatoire est généralement sécuritaire. Le risque pour le patient de présenter un nouvel AVC dans le contexte de la fibrillation auriculaire paroxystique est incertain, mais il semble identique au risque observé dans la fibrillation auriculaire chronique (environ 12% par année). Le traitement par la warfarine peut diminuer ce risque d'à peu près les deux tiers comparé au placebo. Le risque annuel de saignement majeur sous traitement par la warfarine est de 1% à 3%, mais le taux individualisé dépend de différents facteurs de risque spécifiques.

Interprétation:

Il n'existe pas suffisamment de données pour recommander ou ne pas recommander l'électrocardiographie ambulatoire pour la détection de la fibrillation auriculaire paroxystique chez des patients choisis ou non, ayant subi un AVC (recommandation de catégorie C). Il existe des données suffisantes pour recommander l'administration de warfarine chez les patients qui ont subi un AVC et qui font de la fibrillation auriculaire paroxystique (recommandation de catégorie B).

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 27 , Issue 1 , February 2000 , pp. 25 - 31
Copyright
Copyright © The Canadian Journal of Neurological 2000

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