Ion channels and ElectrophysiologyP528Detection of asymptomatic atrial fibrillation episodes during ECG telemonitoring in stroke patients

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Abstract

Introduction

Previously unrecognised paroxismal atrial fibrillation (PAF) could be found in 25% of stroke patients. Previous studies with Holter ECG monitoring and transtelephonic ECG transmition have found that asymptomatic PAF episodes outweigh symptomatic ones nearly 12 times; the risk for complications, however, for both types of PAF is similar.

Objective

To evaluate the possibility to detect PAF episodes using ECG telemonitoring in stroke patients.

Methods

Fifteen patients have already completed the study. The mean age in our study group was 54 ± 11 years, all patients were male, 70% of them - with arterial hypertension, 80% - dyslipidemy, 30% - smokers, 20% - diabetes mellitus. None of the patients had a history of PAF. An eligibility criterion was presence of ischemic stroke in the 2-week-time period before inclusion in the study and no detectable embologenic source. Baseline transthoracic echocardiography was performed before initiation of telemonitoring.

Results

The mean follow-up period was 22 ± 6 days. During this time we were able to detect PAF episodes in three patients (20%), and these subjects were started on an anticoagulation regimen. The baseline characteristics and echocardiographic parameters in the group of subjects with PAF detected during telemonitoring did not show any statistically significant differences when compared with the rest of the study group. During the monitoring period we were able to detect also some other rhythm disturbances: one patient with chronotropic incompetence and persistent sinus tachycardia, which resolved after inclusion of ivabradine; two patients presented with complex ventricular pre-excitation beats – the condition significantly improved after beta-blockade. Frequent supraventricular ectopic beats were found in three other patients but requested no further therapy.

Results

Patients' compliance with the system was excellent: none of the patients refused to complete the monitoring period and none of them complained about some discomfort or adverse reaction.

Conclusion

ECG telemonitoring in stroke patients is feasible and with an excellent compliance. It could detect asymptomatic PAF episodes and therefore determine optimal antiplatelet strategy. ECG telemonitoring has the possibility to detect also some other rhythm disturbances that require pharmacological intervention.

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