Maneesh Bhargava
University of Minnesota, USA
Title: Early aggressive extended cardiac monitoring after acute ischemic stroke for PAF detection: Time to review strategies and guidelines
Biography
Biography: Maneesh Bhargava
Abstract
Paroxysmal Atrial Fibrillation(PAF) is recognised as a significant causative factor in embolic ischemic strokes. However, the paucity of clinical data and clear guidelines regarding timing and duration of non-invasive cardiac monitoring has resulted in variable clinical practice. We analysed our local data to see if early extended cardiac monitoring using R-Test machine makes any difference in PAF detection rates and decision to anticoagulated when compared to late extended cardiac monitoring after discharge. We also reviewed ECHO findings to determine if there was any correlation between dilated left atrium (LA) and PAF
Method: Retrospective study. Patients with presumed embolic stroke without previous history of PAF/AF and no significant carotid disease or lacunar stroke over a period of 1 year were included. Data was collected from available hospital records
Results: Of the 127 patients included, 85 (67%) had inpatient early 72-hour cardiac monitoring and 42(33%) had 72-hour cardiac monitoring after discharge. 37/85(44%) had PAF/AF confirmed on cardiac monitoring. 33/37(90%) patients had anticoagulation decision made while in hospital 2/42(<5%) with late 72-hour cardiac monitoring had AF detected; both patients were anti-coagulated. 19/39(49%) with positive results had dilated LA on ECHO16/39 (41%) positive results were in patients under 75 years
Conclusion: Early extended cardiac monitoring is significantly better in detecting PAF as compared to late monitoring and can make a substantial difference in anti-coagulation rate with potential for risk reduction and long term cost benefit to the health economy. There is an urgent need to review current guidelines and clinical practice