Cryptogenic Acute Ischemic Stroke: Assessment of the Performance of a New Continuous Long-Term Monitoring System in the Detection of Atrial Fibrillation

Abstract Background: Long-term monitoring has been advocated to enhance the detection of atrial fibrillation (AF) in patients with stroke. Objective: To evaluate the performance of a new ambulatory monitoring system with mobile data transmission (PoIP) compared with 24-hour Holter. We also aimed to evaluate the incidence of arrhythmias in patients with and without stroke or transient ischemic attack. Methods: Consecutive patients with and without stroke or TIA, without AF, were matched by propensity score. Participants underwent 24-hour Holter and 7-day PoIP monitoring. Results: We selected 52 of 84 patients (26 with stroke or TIA and 26 controls). Connection and recording times were 156.5 ± 22.5 and 148.8 ± 20.8 hours, with a signal loss of 6,8% and 11,4%, respectively. Connection time was longer in ambulatory (164.3 ± 15.8 h) than in hospitalized patients (148.8 ± 25.6 h) (p = 0.02), while recording time did not differ between them (153.7 ± 16.9 and 143.0 ± 23.3 h). AF episodes were detected in 1 patient with stroke by Holter, and in 7 individuals (1 control and 6 strokes) by PoIP. There was no difference in the incidence of arrhythmias between the groups. Conclusions: Holter and PoIP performed equally well in the first 24 hours. Data transmission loss (4.5%) occurred by a mismatch between signal transmission (2.5G) and signal reception (3G) protocols in cell phone towers (3G). The incidence of arrhythmias was not different between stroke/TIA and control groups.摘要 背景：已有研究倡导采用长期监测手段，以提升卒中患者心房颤动（AF）的检出率。 目的：评估一款搭载移动数据传输功能的新型动态监测系统（PoIP）与24小时动态心电图（Holter）的检测性能；同时对比合并/未合并卒中或短暂性脑缺血发作（TIA）患者的心律失常发生率。 方法：纳入无心房颤动史、合并或未合并卒中/短暂性脑缺血发作的连续病例，通过倾向得分匹配进行分组。所有受试者均接受24小时Holter监测与7天PoIP监测。 结果：本研究共纳入84例患者中的52例（26例合并卒中/TIA，26例为对照）。监测连接时长与记录时长分别为156.5±22.5小时与148.8±20.8小时，信号丢失率分别为6.8%与11.4%。门诊患者的监测连接时长（164.3±15.8 h）长于住院患者（148.8±25.6 h），差异具有统计学意义（p=0.02）；但两组的记录时长无显著差异（分别为153.7±16.9 h与143.0±23.3 h）。Holter仅在1例卒中患者中检出心房颤动发作，而PoIP则在7例受试者中检出（1例对照，6例卒中患者）。两组患者的心律失常发生率无显著差异。 结论：在监测的前24小时内，Holter与PoIP的检测性能相当。本研究中出现的4.5%数据传输丢失，源于手机基站（3G网络）处的信号传输（2.5G）与信号接收（3G）协议不匹配。卒中/TIA组与对照组的心律失常发生率无显著差异。