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Apoplex: Positive results published
Positive results of study on atrial fibrillation with an automatic screening algorithm ASA (SRA) published in Cardiovascular Disease Magazin
In a study for detection of paroxysmal atrial fibrillation in acute stroke patients, clinicians from university hospital at Heidelberg compared in 136 patients SRA (technology from apoplex medical technologies) with the conventional 24 hour long term ECG. While the 24 hour ECG examination revealed 23 % of the patients later found as having paroxysmal atrial fibrillation during monitor surveillance, the SRA test identified 72% with just a one hour examination in the emergency room.
The study has been published at the 18 th of August 2010 , by the department of Neurology in cooperation with the departments of Cardiology and Epidemiology and Aging Reaseach at the German Cancer Reseach Center (DKFZ) at the University of Heidelberg.
Background: Atrial fibrillation (AF) is a frequent cause of stroke, but detecting paroxysmal AF (pAF) poses a challenge. We investigated whether continuous bedside ECG monitoring in a stroke unit detects pAF more sensitively than 24hour Holter ECG, and tested whether examining RR interval dynamics on shortterm ECG recordings using an automated screening algorithm (ASA) for pAF detection is a useful tool to predict the risk of pAF outside periods of manifest AF.
Methods: Patients >60 years with acute ischemic stroke or transient ischemic attacks (TIA) were prospectively enrolled unless initial ECG revealed AF or they had a history of paroxysmal or persistent AF. ASA was performed on 1- to 2hour ECG recordings in the emergency room and patients were classified into 5 risk categories for pAF. All patients underwent continuous bedside ECG monitoring for >48 h. Additionally, 24hour Holter ECG was performed. Results: 136 patients were enrolled (median age: 72 years, male: 58.8%). In 29 (21.3%), pAF was newly diagnosed by continuous bedside ECG monitoring. pAF increased with age (p = 0.031). Median time to first pAF detection on continuous bedside ECG monitoring was 36 h. In 16 patients, pAF was detected by continuous bedside ECG monitoring prior to the performance of 24hour Holter ECG. Thirteen of the remaining patients were pAF positive on continuous bedside ECG monitoring, but 24hour Holter detected only 3 patients. Accordingly, the sensitivity of 24hour Holter was 0.23. Sensitivity of higherrisk categories of ASA compared to continuous bedside ECG monitoring was 0.72, and specificity 0.63.
Conclusion: Continuous bedside ECG monitoring is more sensitive than 24hour Holter ECG for pAF detection in acute stroke/TIA patients. Screening patients for pAF outside AF episodes using ASA requires further development.
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