BMJ Open (Sep 2020)

Diagnostic yield of chest and thumb ECG after cryptogenic stroke, Transient ECG Assessment in Stroke Evaluation (TEASE): an observational trial

  • Silvia De Sanjosé,
  • Vanesa Garcia,
  • Octavio Arencibia,
  • Virginia Benito,
  • Amina Lubrano,
  • Miguel Andujar,
  • Esther Roura,
  • Alejandra Torres,
  • Begoña Vega,
  • Marta Pavcovich,
  • Miguel Angel Sanchez,
  • Jose Luis Trujillo,
  • Lucia Almeida,
  • Milagros Santana,
  • Rosaura Hurtado,
  • Norberto Medina,
  • Sonia Carballo,
  • Maria del Carmen Camacho,
  • Arancha Ruiz del Pozo,
  • Alfoso Quesada,
  • Eduardo Salido,
  • Laia Bruni,
  • Diana Alemán,
  • Mónica Almeida,
  • Ana María Arencibia,
  • María Isabel Armas,
  • Guillermina Batista,
  • Victoria Bernal,
  • Francisca Bernaldo de Quirós,
  • Sili Bolaños,
  • Dolores Casaña,
  • Luisa Celedón,
  • Isabel Cruz,
  • Elisa Díaz,
  • Inocencia Duarte,
  • Felisa Expósito,
  • Carmelo Felipe,
  • Carlos Galván,
  • María José García,
  • María Isabel García,
  • Virginia García,
  • Elena Giménez,
  • Teresa Godoy,
  • Catalina Gómez,
  • Lucia González,
  • Luisa Gutiérrez,
  • Mónica Hernández,
  • Delia Herrera,
  • Laura Herrera,
  • Rosario Laseca,
  • Carmen Marrero,
  • Ofelia Marrero,
  • Noa Mateos,
  • Olivia Medina,
  • Josefa Mendoza,
  • Lucia Montesdeoca,
  • Rosa Monzón,
  • Cristina Morales,
  • Mercedes Morales,
  • M Dolores Navarro,
  • María Ángeles Nieto,
  • Noelia Pérez,
  • Yurena Pérez,
  • Antonio Ramos,
  • Antonio Rico,
  • Margarita Roldán,
  • Esther Salamanca,
  • Rosario Sánchez,
  • Raquel Santana,
  • Elvira Santos,
  • Antonia Solanes,
  • Elisabeth Soutto,
  • Dulce Suarez,
  • María Jesús Suárez,
  • María Ángeles Tadeo,
  • Virgen Valdés,
  • Gabriela Valido,
  • Iralla Vega,
  • Maria del Pino Vega,
  • María Angeles Afonso,
  • Elisa Baena,
  • María Pilar Baz,
  • José de Armas,
  • Alicia de la Puerta,
  • Josefina García,
  • María Asuncion González,
  • Célida González,
  • María Teresa Hernández,
  • Josefa Limiñana,
  • Carmen Rosa León,
  • Fernando Marín,
  • Emma Manrique,
  • José Roberto Negrín,
  • Rosa Olavarrieta,
  • Verónica Perera,
  • Concepción Sabater,
  • Candelaria Sosvilla

DOI
https://doi.org/10.1136/bmjopen-2020-037573
Journal volume & issue
Vol. 10, no. 9

Abstract

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Objective In stroke survivors, atrial fibrillation (AF) is typically evaluated solely by short-term ECG monitoring in the stroke unit. Prolonged continuous ECG monitoring or insertable cardiac monitors require substantial resources. Chest and thumb ECG could provide an alternative means of AF detection, which in turn could allow prompt anticoagulation to prevent recurrent stroke. The objective of this study was to assess the yield of newly diagnosed AF during 28 days of chest and thumb ECG monitoring two times per day in cryptogenic stroke.Methods This study, Transient ECG Assessment in Stroke Evaluation, included patients who had a stroke from Region Gävleborg, Sweden, between 2017 and 2019. Patients with a recent ischaemic stroke without documented AF (or other reasons for anticoagulation) before or during ECG evaluation in the stroke unit were evaluated using the Coala Heart Monitor connected to a smartphone application for remote monitoring.Results The prespecified number of 100 patients (mean age 67.6±10.8 years; 60% men) was analysed. In nine patients (9%, number needed to screen 11) AF but no other significant atrial arrhythmias (>30 s) was diagnosed. The mean CHA2DS2-VASc score was similar among patients with AF and no AF (4.9±1.1 vs 4.3±1.3; p=0.224) and patients with AF were older (74.3±9.0 vs 66.9±10.8; p=0.049). Patients performed on average 90.1%±15.0% of scheduled transmissions.Conclusion In evaluation of cryptogenic stroke, 9% of patients had AF detected using chest and thumb ECG two times per day during 1 month. In many stroke survivors, this is a feasible approach and they will be potentially protected from recurrent stroke by anticoagulation treatment.Trial registration number NCT03301662.