DETECTION OF ATRIAL FIBRILLATION WITH PROLONGED HEART RATE MONITORING IN PATIENTS WITH ISCHEMIC STROKE OF UNDETERMINED ETIOLOGY
Introduction. Latent forms of atrial fibrillation can be the cause of ischemic stroke of undetermined etiology in one third of patients, due to thrombus formation in the heart chambers. Methods for heart rate monitoring are widely presented today, but there is no unitary approach to this issue. Aim of the study. To reduce the number of recurrent strokes by detecting atrial fibrillation. Methods. The «case-control» study included 288 patients with ischemic stroke of undetermined etiology. 155 of which were continuously monitored for heart rhythm for 48 hours. The study group (n = 133) underwent heart rate monitoring using a smartphone-based device. Statistical analysis. Quantitative variables were assessed for normality using the Kolmogorov-Smirnov test (when the number of subjects was more than 50). Quantitative variables following non normal distribution were described using median (Me) and lower and upper quartiles (Q1 – Q3). Mann-Whitney U-test was used to compare two groups on a quantitative variable whose distribution differed from the normal distribution. Categorical data were described with absolute and relative frequencies. When analyzing dependent variable between two related groups, the McNemar test was used. Comparison of frequencies in the analysis of multifield contingency tables was performed using Fisher's exact test (for expected values less than 10). Comparison of frequencies in the analysis of 2 by 2 contingency tables was performed using Pearson's chi-square test (for expected values greater than 10). Results. Atrial fibrillation was detected in 4 (2.6%) patients with heart rate monitoring for 24 hours, in the next 24 hours an additional 3 patients with atrial fibrillation were detected, for a total of 7 (4.5%) patients with 48-hour monitoring. Intermittent ECG recording using a smartphone-based device made it possible to record atrial fibrillation in 11 (8.3%) patients. Statistically significant differences in the incidence of atrial fibrillation were obtained in a pair of comparison between 24-hour Holter monitoring (2.6%) and monitoring using a smartphone-based device (8.3%) (p = 0.035). When comparing gender, age, proportion of patients with coronary heart disease, CHAD2DS2VASc scores depending on the presence of atrial fibrillation on any device, we found statistically significant differences (p = 0.003, p <0.001, p = 0.042, p <0.001, respectively ) Results. ECG recording during the entire hospital stay in patients with cryptogenic stroke using a smartphone-based device for 30 seconds three times a day and in the presence of symptoms showed a better detectability of atrial fibrillation, compared with continuous, but short (24-48 hours ) recording an ECG. As a result of the detection of this rhythm disturbance, the doctor makes an important decision on the prescription of antiarrhythmic and anticoagulant drugs to prevent a recurrent stroke, which may result in disability or death of the patient. The implementation of a smartphone-based device into the routine practice is not technically difficult, and the result is saving the life and prevention of patient disability.
Idaliya R. Rakhimova1, https://orcid.org/0000-0002-9011-2879 Talgat N. Khaibullin1, https://orcid.org/0000-0003-1886-0538 Zhanar S. Abdrakhmanova2, https://orcid.org/0000-0002-1890-0862 Vladimir V. Kovalchuk3, https://orcid.org/0000-0002-1004-2162 Ayan S. Abdrakhmanov4, https://orcid.org/0000-0001-6315-5016 1NJSC "Semey Medical University", Semey, Republic of Kazakhstan; 2 NJSC "Astana Medical University", Nur-Sultan, Republic of Kazakhstan; 3 City hospital №38 named after O.N. Semashko, Saint Petersburg, Russian Federation; 4 National Scientific Cardiac Surgery Center, Nur-Sultan, Republic of Kazakhstan.
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Rakhimova I.R., Khaibullin T.N., Abdrakhmanova Zh.S., Kovalchuk V.V., Abdrakhmanov A.S. Detection of atrial fibrillation with prolonged heart rate monitoring in patients with ischemic stroke of undetermined etiology // Nauka i Zdravookhranenie [Science & Healthcare]. 2021, (Vol.23) 5, pp. 85-92. doi 10.34689/SH.2021.23.5.010