medigraphic.com
Órgano Oficial del Hospital Angeles Health System

2016, Number 1

<< Back Next >>

Acta Med 2016; 14 (1)

Long time Holter monitoring in stroke patient

Arellano AJG, Salas GI, López BA, Domínguez CLG

Language: Spanish
References: 14
Page: 32-35
PDF size: 245.30 Kb.


ABSTRACT

Background: Paroxysmal atrial fibrillation (PAF) is a form of self-limited and recurrent cardiac arrhythmia, comprising between 25 and 62% of cases, may manifest as a brief episode or periods of varying duration, which are subdiagnosed, mainly in patients with transient ischemic attack and/or stroke. Clinical case: 76 years old male, who started four days earlier with paresthesia in left upper and lower members, which evolved to left hemiplegia. By submitting multiple infarcts in NMR proceeded to determine origin; the trans-esophageal echocardiogram showed atrial septum aneurysm 22 mm; with Holter monitoring were captured three episodes of paroxysmal atrial fibrillation until the 6th day; the longest lasting 4.3 minutes, prescribing anticoagulation with support. Conclusions: Avoid to catalog patients with cryptogenic stroke like unknown origin with negative results in single 24-hour Holter. The discovery of PAF in patients with transient ischemic attack and/or stroke has diagnostic and therapeutic implications on primary and secondary stroke prevention respectively. Prolonged Holter monitoring must be used because the cost-benefit is fully justified.


REFERENCES

  1. Tsang TS, Petty GW, Barnes ME, O’Fallon WM, Bailey KR, Wiebers DO et al. The prevalence of atrial fibrillation in incident stroke cases and matched population controls in Rochester, Minnesota: changes over three decades. J Am Coll Cardiol. 2003; 42: 93-100.

  2. Lamassa M, Di Carlo A, Pracucci G, Basile AM, Trefoloni G, Vanni P. Characteristics, outcome, and care of stroke associated with atrial fibrillation in Europe: data from a multicenter multinational hospital-based registry (the European Community Stroke Project). Stroke. 2001; 32: 392-398.

  3. Sancho PA, Labrador FJ. Aneurismas del tabique interauricular. Presentación de tres casos. Rev Esp Cardiol. 2000; 53: 1129-1131.

  4. Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011; 42: 227-276.

  5. Bang OY, Lee PH, Joo SY, Lee JS, Joo IS, Huh K. Frequency and mechanisms of stroke recurrence after cryptogenic stroke. Ann Neurol. 2003; 54: 227-234.

  6. Rizos T, Rasch C, Jenetzky E, Hametner C, Kathoefer S, Reinhardt R et al. Detection of paroxysmal atrial fibrillation in acute stroke patients. Cerebrovasc Dis. 2010; 30: 410-417.

  7. Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010; 31: 2369-2429.

  8. Zimetbaum P, Goldman A. Ambulatory arrhythmia monitoring: choosing the right device. Circulation. 2010; 122: 1629-1636.

  9. Dion F, Saudeau D, Bonnaud I, Friocourt P, Bonneau A, Poret P et al. Unexpected low prevalence of atrial fibrillation in cryptogenic ischemic stroke: a prospective study. J Interv Card Electrophysiol. 2010; 28: 101-107.

  10. Botto GL, Padeletti L, Santini M, Capucci A, Gulizia M, Zolezzi F et al. Presence and duration of atrial fibrillation detected by continuous monitoring: crucial implications for the risk of thromboembolic events. J Cardiovasc Electrophysiol. 2009; 20: 241-248.

  11. Raymond CS, Seet RC, Friedman PA, Rabunstein AA. Prolonged rhythm monitoring for the detection of occult paroxysmal atrial fibrillation in ischemic stroke of unknown cause. Circulation. 2011; 124: 477-486.

  12. Oppenheimer S. Cerebrogenic cardiac arrhythmias: cortical lateralization and clinical significance. Clin Auton Res. 2006; 16: 6-11.

  13. Scheitz JF, Erdur H, Haeusler KG, Audebert HJ, Roser M et al. Insular cortex lesions, cardiac troponin, and detection of previously unknown atrial fibrillation in acute ischemic stroke: insights from the troponin elevation in acute ischemic stroke study. Stroke. 2015; 46 (5): 1196-1201. doi: 10.1161/STROKEAHA.115.1008681.Epub 2015 Apr 2.

  14. Hart RG, Pearce LA, Miller VT, Anderson DC, Rothrock JF, Albers GW, et al. Cardioembolic vs. noncardioembolic strokes in atrial fibrillation: frequency and effect of antithrombotic agents in the stroke prevention in atrial fibrillation studies. Cerebrovasc Dis. 2000; 10: 39-43.




2020     |     www.medigraphic.com