Lancet Neurology-system centrally monitors atrial fibrillation, which can help detect cerebral ischemic events

Atrial fibrillation is associated with a four to five-fold increase in stroke risk and may account for every five ischemic strokes worldwide
.

The guidelines recommend that patients with atrial fibrillation (including patients with paroxysmal atrial fibrillation) long-term use oral anticoagulants for secondary stroke prevention

Prevent stroke

Two large randomized studies have shown that in patients with embolic stroke (ESUS) of undetermined origin, anticoagulant therapy with rivaroxaban or dabigatran has no advantage over aspirin
.

Therefore, the diagnosis of atrial fibrillation is still a prerequisite for identifying stroke patients who can benefit from anticoagulation therapy.

diagnosis

Some studies have shown that long-term ECG monitoring can increase the detection rate of concealed atrial fibrillation after ischemic stroke
.

However, it is unclear how long ECG monitoring should be performed after stroke and how to ensure the feasibility of mobile ECG monitoring

Importantly, there are no published randomized studies that can evaluate the effects of long-term ECG monitoring of anticoagulant use, or the subsequent reduction of recurrence or death in stroke patients

In this randomized, open-label, parallel grouped multi-center study initiated by the researchers, Karl Georg Haeusler of the Berlin Stroke Research Center and others recruited at least 18 years old from 38 accredited stroke units in Germany Of patients with acute ischemic stroke or transient ischemic attack, but are not known to have atrial fibrillation
.

Patients were randomly assigned (1:1) to receive routine diagnostic procedures for atrial fibrillation detection (control group) or additional Holter-ECG recording for up to 7 days in the hospital (intervention group)
.

The patients are stratified by center, and a randomized block design is adopted

Secondary results include the number of hospitalized patients newly diagnosed with atrial fibrillation, as well as the combined status of recurring stroke, major bleeding, myocardial infarction, or death after 6, 12, and 24 months
.

Myocardial infarction

A total of 3465 patients were randomly assigned, 1735 (50-1%) were assigned to the intervention group, and 1730 (49-9%) were assigned to the control group
.

2920 (
84.

3% of patients had oral anticoagulation at 12 months (1484 in the intervention group, 1436 in the control group)

Atrial fibrillation was newly found in 97 people (5-8%) in the intervention group of 1714 people during their hospitalization, while atrial fibrillation was newly found in 68 people (4-0%) in the control group of 1717 people
.

At 24 months, between patients randomly assigned to the control group of patients in the intervention group heart blood vessels results and consolidation of death there is no difference
.

At 24 months, between patients randomly assigned to the control group of patients in the intervention group heart blood vessels results and consolidation of death there is no difference
.

At 24 months, between patients randomly assigned to the control group of patients in the intervention group heart blood vessels results and consolidation of death there is no difference

The important significance of this study is that: Systematic core centrally reviewed ECG monitoring is feasible, which can improve the detection rate of atrial fibrillation in hospitalized patients with acute ischemic stroke or transient ischemic attack
.

However, it has been found that systemic ECG monitoring has no effect on the use of oral anticoagulants after 12 months, and further efforts are needed to improve secondary stroke prevention

Systematic core centrally reviewed ECG monitoring is feasible, which can improve the detection rate of atrial fibrillation in hospitalized patients with acute ischemic stroke or transient ischemic attack

Original source
Haeusler KG, Kirchhof P, Kunze C, Tütüncü S, Fiessler C, Malsch C, Olma MC, Jawad-Ul-Qamar M, Krämer M, Wachter R, Michalski D, Kraft A, Rizos T, Gröschel K, Thomalla G , Nabavi DG, Röther J, Laufs U, Veltkamp R, Heuschmann PU, Endres M; MonDAFIS Investigators.
Systematic monitoring for detection of atrial fibrillation in patients with acute ischaemic stroke (MonDAFIS): a randomised, open-label, multicentre study.
Lancet Neurol.
2021 Jun;20(6):426-436.
doi: 10.
1016/S1474-4422(21)00067-3.
PMID: 34022169.

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