Value of routine Holter monitoring for the detection of paroxysmal atrial fibrillation in patients with cerebral ischemic events

Background and Purpose-Holter monitoring for the detection of paroxysmal atrial fibrillation (PAF) is a routine procedure after cerebral ischemic events, although its value is unknown. The aim of this study was to evaluate the incidence of PAF and its impact on drug treatment modifications in this population. Methods-Retrospective evaluation of all Holter ECGs in patients with cerebral ischemic events was done. Chart analysis with regard to drug treatment modification and cardiovascular drug therapy was performed in all patients. Results-Between January 2000 and December 2002, 425 hospitalized patients ( median age, 68 years) had routine Holter ECG after a cerebral ischemic event. PAF was diagnosed in 9 patients (2.1%): in 2, oral anticoagulation was contraindicated; 1 had severe carotid stenosis as an additional risk factor; 1 had PAF but was on oral anticoagulation for basilar thrombosis; 2 had had PAF before and were on aspirin; and 3 had a new diagnosis of PAF. The last 5 patients were put on oral anticoagulation. Thus, routine Holter ECG resulted in drug treatment modification in only 5 of 425 patients (1.2%). Conclusions-PAF in cerebral ischemic event patients has a low incidence and, if diagnosed, rarely leads to drug modification. Therefore, routine Holter monitoring for PAF screening is not recommended in this patient population.