564 Rev Esp Cardiol. 2009;62(5):564-7 Cardiac Monitoring in Stroke Units: Importance of Diagnosing Atrial Fibrillation in Acute Ischemic Stroke Rosa María Vivanco Hidalgo, Ana Rodríguez Campello, Ángel Ois Santiago, Elisa Cuadrado Godia, Claustre Pont Sunyer, and Jaume Roquer Servicio de Neurología, Unidad de Neurovascular, Hospital del Mar, Barcelona, Spain BRIEF REPORTS Correspondence: Dr. R.M. Vivanco Hidalgo. Servicio de Neurología. Unidad de Neurovascular. Hospital del Mar. Pg. Marítim, 25-29. 08003 Barcelona. España. E-mail: 96007@imas.imim.is Received December 29, 2007. Accepted for publication June 17, 2008. In patients with stroke, atrial fibrillation is an independent risk factor and indicates a poor prognosis. Cardiac monitoring is carried out for longer periods in stroke units. The aim of this study was to determine the frequency at which atrial fibrillation is detected in stroke units and the percentage of patients with acute ischemic stroke or transient ischemic attack who receive anticoagulant therapy. The study included 465 patients, who were monitored in a stroke unit for an average of 54.55 (35.74) h. Atrial fibrillation was detected in 33 (48.5% had paroxysmal atrial fibrillation and 51.5% had persistent atrial fibrillation). The most common risk factor was hypertension. Anticoagulation therapy was started in 57.5%. In conclusion, use of cardiac monitoring in a stroke unit was useful for detecting atrial fibrillation in patients with acute stroke and resulted in treatment modification in more than half the affected patients. Key words: Atrial fibrillation. Stroke unit. Anticoagulant therapy. Monitorización cardiaca en la unidad de ictus: importancia del diagnóstico de fibrilación auricular en el ictus isquémico agudo La fibrilación auricular (FA) es un factor de riesgo inde- pendiente y predictor de mal pronóstico en el ictus. La unidad de ictus (UI) prolonga la monitorización cardiaca. El objetivo del estudio fue determinar la frecuencia de FA detectada en la UI y el porcentaje de pacientes con ictus isquémico o accidente isquémico transitorio a quienes se dio tratamiento anticoagulante. Se incluyó a 465 pacientes monitorizados en la UI du- rante una media de 54,55 ± 35,74 h. Se detectó FA en 33 (el 48,5%, FA paroxística, y el 51,5%, FA persistente). El factor de riesgo más frecuente fue la hipertensión arterial. Se inició tratamiento anticoagulante en el 57,5%. Concluimos que la monitorización en la UI es útil para la detección de FA en el ictus agudo y modifica el trata- miento en más de la mitad de los pacientes afectados. Palabras clave: Fibrilación auricular. Unidad de ictus. Tratamiento anticoagulante. INTRODUCTION Patients with transient ischemic attack (TIA) or established stroke are those most at risk of recurrence (10.5% at 90 days), and this is greatest in the first week. 1 Cardiogenic embolism causes 20% of strokes, and atrial fibrillation (AF) 50%. The most common form, nonvalvular, occurs in 6% of patients aged 65 and arrhythmia is the principal cause in older patients. Both AF and paroxysmal AF (PAF) clearly indicate risk of a first or recurrent stroke and are associate with poor prognosis. Recurrent events may account for 12%-30% per year. 2 Given that anticoagulation therapy reduces risk of recurrence, detecting AF after stroke is fundamental to optimizing treatment but underdiagnosis of AF continues. Over 30% of patients are unaware of their diagnosis and 25% of those with stroke had no previous diagnosis. Moreover, in 30% the pattern is intermittent. Due to the low sensitivity of standard electro- cardiography, 24-hour ECG recording (Holter) is frequently used. 3 Holter facilitates detection of previously unknown AF in approximately 2% of patients with stroke. If recording is extended from 24 to 72 hours, frequency of PAF increases from 1.2% to 6.1%, indicating that longer recording times improve chances of detection. 4 Several studies show care of patients with acute cerebrovascular disease in the stroke unit (SU) reduces morbidity and mortality, and need for Document downloaded from https://www.revespcardiol.org/, day 15/12/2021. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from https://www.revespcardiol.org/, day 15/12/2021. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.