Journal ArticleDOI
Holter-electrocardiogram-monitoring in patients with acute ischaemic stroke (Find-AFRANDOMISED): an open-label randomised controlled trial
Rolf Wachter,Klaus Gröschel,Götz Gelbrich,Gerhard F. Hamann,Pawel Kermer,Jan Liman,Joachim Seegers,Katrin Wasser,Anna Schulte,Falko Jürries,Anna Messerschmid,Nico Behnke,Sonja Gröschel,Timo Uphaus,Anne Grings,Tugba Ibis,Sven Klimpe,Michaela Wagner-Heck,Magdalena Arnold,Evgeny Protsenko,Peter U. Heuschmann,David Conen,Mark Weber-Krüger +22 more
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Find-AFrandomised supports the consideration of all patients aged 60 years or older with stroke for prolonged monitoring if the detection of atrial fibrillation would result in a change in medical management (eg, initiation of anticoagulation).Abstract:
Summary Background Atrial fibrillation is a major risk factor for recurrent ischaemic stroke, but often remains undiagnosed in patients who have had an acute ischaemic stroke. Enhanced and prolonged Holter-electrocardiogram-monitoring might increase detection of atrial fibrillation. We therefore investigated whether enhanced and prolonged rhythm monitoring was better for detection of atrial fibrillation than standard care procedures in patients with acute ischaemic stroke. Methods Find-AF randomised is an open-label randomised study done at four centres in Germany. We recruited patients with acute ischaemic stroke (symptoms for 7 days or less) aged 60 years or older presenting with sinus rhythm and without history of atrial fibrillation. Patients were included irrespective of the suspected cause of stroke, unless they had a severe ipsilateral carotid or intracranial artery stenosis, which were the exclusion criteria. We used a computer-generated allocation sequence to randomly assign patients in a 1:1 ratio with permuted block sizes of 2, 4, 6, and 8, stratified by centre, to enhanced and prolonged monitoring (ie, 10-day Holter-electrocardiogram [ECG]-monitoring at baseline, and at 3 months and 6 months of follow-up) or standard care procedures (ie, at least 24 h of rhythm monitoring). Participants and study physicians were not masked to group assignment, but the expert committees that adjudicated endpoints were. The primary endpoint was the occurrence of atrial fibrillation or atrial flutter (30 sec or longer) within 6 months after randomisation and before stroke recurrence. Because Holter ECG is a widely used procedure and not known to harm patients, we chose not to assess safety in detail. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01855035. Findings Between May 8, 2013, and Aug 31, 2014, we recruited 398 patients. 200 patients were randomly assigned to the enhanced and prolonged monitoring group and 198 to the standard care group. After 6 months, we detected atrial fibrillation in 14% of 200 patients in the enhanced and prolonged monitoring group (27 patients) versus 5% in the control group (nine of 198 patients, absolute difference 9·0%; 95% CI 3·4–14·5, p=0·002; number needed to screen 11). Interpretation Enhanced and prolonged monitoring initiated early in patients with acute ischaemic stroke aged 60 years or older was better than standard care for the detection of atrial fibrillation. These findings support the consideration of all patients aged 60 years or older with stroke for prolonged monitoring if the detection of atrial fibrillation would result in a change in medical management (eg, initiation of anticoagulation). Funding Boehringer Ingelheim.read more
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Systematic monitoring for detection of atrial fibrillation in patients with acute ischaemic stroke (MonDAFIS): a randomised, open-label, multicentre study.
Karl Georg Haeusler,Paulus Kirchhof,Claudia Kunze,Serdar Tütüncü,Cornelia Fiessler,Carolin Malsch,Manuel C. Olma,Muhammad Jawad-Ul-Qamar,Muhammad Jawad-Ul-Qamar,Michael Krämer,Rolf Wachter,Rolf Wachter,Dominik Michalski,Andrea Kraft,Timolaos Rizos,Klaus Gröschel,Götz Thomalla,D. G. Nabavi,Joachim Röther,Ulrich Laufs,Roland Veltkamp,Peter U. Heuschmann,Matthias Endres,Michael Bauerle,Michael Besselmann,T Büttner,Petra Dem,Jens Diekmann,Joanna Dietzel,Rainer Dziewas,Sven Ehrlich,Annette Evens,Georg Gahn,Albrecht Günther,Gerhard F. Hamann,Andreas Hartmann,Karen Louise Harvey,Fedor Heidenreich,T Helberg,Carsten Hobohm,F Hoffmann,Olaf Hoffmann,Gerhard J Jungehulsing,Eva-Maria Kampschulte,Peter Kraft,Christos Krogias,Elke Leinisch,Matthias Maschke,Stefan Merkelbach,Johannes Muehler,Ludwig Niehaus,Gesa Nören,P Oschmann,Frederick Palm,Gabor C. Petzold,Larissa Pfeiler,Waltraud Pfeilschifter,Marie Prince,Peter A. Ringleb,Michael Rosenkranz,Georg Royl,Renate B Schnabel,Johannes Schurig,A Steinbrecher,Robert Stingele,Christian Tanislav,Louise Tyler,Christian Urbanek +67 more
TL;DR: In this article, the effect of systematic electrocardiogram (ECG) monitoring of patients in hospital on the rate of oral anticoagulant use after 12 months was assessed.
Journal ArticleDOI
Stroke Etiology and Thrombus Computed Tomography Characteristics in Patients With Acute Ischemic Stroke A MR CLEAN Registry Substudy
Nikki Boodt,Kars C.J. Compagne,Bruna Garbugio Dutra,Noor Samuels,Manon L. Tolhuisen,Heitor C.B.R. Alves,Manon Kappelhof,Geert J. Lycklama à Nijeholt,Henk A. Marquering,Charles B. L. M. Majoie,Hester F. Lingsma,Diederik W.J. Dippel,Aad van der Lugt +12 more
TL;DR: This study supports the general hypothesis that many cryptogenic strokes have a cardioembolic cause and focuses on the use of thrombus computed tomography characteristics as a diagnostic tool for stroke cause in clinical practice.
Journal ArticleDOI
Prolonged Cardiac Rhythm Monitoring and Secondary Stroke Prevention in Patients With Cryptogenic Cerebral Ischemia
Georgios Tsivgoulis,Georgios Tsivgoulis,Aristeidis H. Katsanos,Aristeidis H. Katsanos,Brian Mac Grory,Martin Köhrmann,Brittany A Ricci,Konstantinos Tsioufis,Konstantinos Tsioufis,Shawna Cutting,Christos Krogias,Peter D. Schellinger,Ana Rodríguez Campello,Elisa Cuadrado-Godia,David J. Gladstone,Tommaso Sanna,Rolf Wachter,Karen L. Furie,Andrei V. Alexandrov,Shadi Yaghi +19 more
TL;DR: Preliminary evidence is provided for a potential impact of PCM on secondary stroke prevention, as patients with cryptogenic IS/TIA undergoing PCM had higher rates of atrial fibrillation detection, anticoagulant initiation, and lower stroke recurrence.
Journal ArticleDOI
Newer technologies for detection of atrial fibrillation
Nath Zungsontiporn,Mark S. Link +1 more
TL;DR: A review of technologies developed in recent years that can potentially enhance the detection of atrial fibrillation and overcome certain limitations of the conventional methods examines the evidence supporting the use of some of these technologies and evaluates their applications in certain clinical scenarios.
Journal ArticleDOI
Atrial Fibrillation Known Before or Detected After Stroke Share Similar Risk of Ischemic Stroke Recurrence and Death.
Xiaomeng Yang,Zhen-Zhen Rao,Hongqiu Gu,Xingquan Zhao,Chunjuan Wang,Liping Liu,Chelsea Liu,Yilong Wang,Zixiao Li,Rui-Ping Xiao,Yongjun Wang +10 more
TL;DR: This study showed that AFDAS had similar risk of 1-year ischemic stroke recurrence and mortality when compared with KAF and higher risk whenCompared with SR, and appropriate treatment is needed to achieve reduction in the incidence of stroke recurrent and mortality.
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