Factors affecting reasonable duration of continuous electrocardiographic monitoring to detect atrial fibrillation in acute ischemic stroke

Chie Tsunetoshi; Kenzo Tsunetoshi; Osamu Komori; Yoshifumi Higashino; Makoto Isozaki; Yoshikazu Arai; Hiroshi Arai; Shintaro Yamada; Hidetaka Arishima; Mika Hasegawa; Kenichiro Kikuta

doi:10.1016/j.jstrokecerebrovasdis.2023.107173

Factors affecting reasonable duration of continuous electrocardiographic monitoring to detect atrial fibrillation in acute ischemic stroke

J Stroke Cerebrovasc Dis. 2023 Aug;32(8):107173. doi: 10.1016/j.jstrokecerebrovasdis.2023.107173. Epub 2023 May 13.

Authors

Affiliations

¹ Department of Community Health Nursing, Division of Nursing, Faculty of Medical Sciences, University of Fukui, Japan.
² Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Japan.
³ Department of Computer and Information Science, Faculty of Science and Technology, Seikei University, Japan; School of Statistical Thinking, The Institute of Statistical Mathematics, Japan.
⁴ Department of Neurosurgery, Tsuruga Municipal Hospital, Japan.
⁵ Department of Neurosurgery, Sugita Genpaku Memorial Obama Municipal Hospital, Japan.
⁶ Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Japan. Electronic address: kikuta@u-fukui.ac.jp.

PMID: 37186969
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107173

Abstract

Background: To examine the reasonable duration of continuous electrocardiographic monitoring (CEM) to detect AF at acute ischemic stroke.

Materials and method: 811 consecutive patients admitted to Tsuruga Municipal Hospital by acute ischemic stroke between April 2013 and December 2021 were enrolled in this study. Excluding 78 patients, 733 patients were analyzed by cluster analysis with SurvCART algorithm, followed by Kaplan-Meier analysis.

Results: The analysis provided step graphs for 8 subgroups. The duration of CEM to achieve the sensitivity of 0.8, 0.9, and 0.95 in each could be calculated. The duration of CEM to achieve the sensitivity of 0.8 are 18 days in female patients with heart failure (HF) (subgroup 1), 24 days in male patients with HF (subgroup 2), 22 days in patients without HF with arterial occlusion and pulse rate (PR) more than 91 (subgroup 3), 24 days in patients without HF with occlusion with PR less than 91 (subgroup 4), 18 days in patients without HF without occlusion with lacuna (subgroup 5), 26 days in patients without HF, occlusion, and lacuna, with arterial stenosis (subgroup 6), 15 days in patients without HF, occlusion, lacuna, and stenosis with BMI more than 21%(subgroup 7), and 44 days in patients without HF, occlusion, lacuna, stenosis and with BMI less than 21% (subgroup 8).

Conclusions: Duration of CEM with the sensitivity of 0.8, 0.9, and 0.95 could be determined by presence of HF, female sex, arterial occlusion, PR more than 91/minute, presence of lacuna, presence of stenosis, and BMI more than 21%. (250).

Keywords: Area under curve; Atrial fibrillation; Electrocardiography; Stroke.

MeSH terms

Arterial Occlusive Diseases*
Atrial Fibrillation* / complications
Atrial Fibrillation* / diagnosis
Constriction, Pathologic
Female
Heart Failure* / diagnosis
Heart Rate
Humans
Ischemic Stroke*
Male