RESUMO
Atrial fibrillation (AF) is the major cause of cardioembolic stroke. It often remains occult when asymptomatic and paroxysmal. We hypothesized that the detection of AF after acute ischemic stroke (AIS) or transient ischemic attack (TIA) could be improved by using continuous cardiac monitoring (CCM) immediately after admission. We sought to determine the detection rate of AF by immediate in-hospital CCM after cryptogenic and noncryptogenic AIS or TIA in patients without a previous diagnosis of AF. We retrospectively studied a cohort of 155 patients with cryptogenic and noncryptogenic AIS or TIA without known AF. We compared the detection rates of newly diagnosed AF (NDAF) in patients admitted to areas with CCM and those never admitted to these areas. We developed a multiple logistic regression model for identifying predictors of NDAF. We characterized NDAF episodes and analyzed how the availability of CCM data changed secondary prevention strategies. We detected NDAF in 21 patients (13.5%). Diagnostic rates of NDAF in patients who underwent CCM and those who did not undergo CCM were 18.2% and 2.2%, respectively (P = .005). The median time from admission to recognition of NDAF was 2.0 days. Most NDAFs were paroxysmal (95.2%) and lasted less than 1 hour (85.7%). Diabetes mellitus and infarct size were predictors of NDAF. Detection of NDAF prompted the initiation of anticoagulation therapy in 8.2% of the patients admitted to areas with CCM availability. Our findings suggest that immediate and prolonged CCM significantly improves the detection of NDAF after cryptogenic and noncryptogenic AIS or TIA, and that diabetes mellitus and infarct size are significantly associated with NDAF.
Assuntos
Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Isquemia Encefálica/etiologia , Serviços Médicos de Emergência/normas , Ataque Isquêmico Transitório/etiologia , Monitorização Fisiológica/normas , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/fisiopatologia , Isquemia Encefálica/fisiopatologia , Estudos de Coortes , Diagnóstico Precoce , Serviços Médicos de Emergência/métodos , Feminino , Humanos , Ataque Isquêmico Transitório/fisiopatologia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Estudos RetrospectivosRESUMO
El 5 por ciento de los aneurismas micóticos (AM) se ubica en el territorio carotídeo y la localización en su sector extracraneal es extremadamente rara...Se presenta un paciente con pseudoaneurisma micótico de la arteria carótida extracraneal secundario a infección parafaríngea, complicado con infarto cerebral y tratado con ligadura de vaso
Assuntos
Humanos , Adenoma , Falso Aneurisma , Artéria Carótida Primitiva/patologia , Círculo Arterial do Cérebro , Imagem Ecoplanar , Infecções/diagnóstico , Pescoço , Faringe , Tomografia Computadorizada por Raios XRESUMO
El 5 por ciento de los aneurismas micóticos (AM) se ubica en el territorio carotídeo y la localización en su sector extracraneal es extremadamente rara...Se presenta un paciente con pseudoaneurisma micótico de la arteria carótida extracraneal secundario a infección parafaríngea, complicado con infarto cerebral y tratado con ligadura de vaso(AU)