Stroke: dysrhythmias occurred in patients with TIAs.

Clinical bottom line (level 4)

  1. A twentieth of patients with transient ischaemic attacks had atrial fibrillation or flutter related to the embolism.
  2. A fifth of patients had bradyarrhythmia possibly related to the embolism.
  3. A sixth of patients had bradytachyarrhythnia possibly associated with the embolism.
Koudstaal et al: Stroke 1986; 17 (2): 192-195
Expires May 2003

The study

Setting: neurological department of a university hospital, The Netherlands

100 patients (aged range 22 to 80 years; mean 61, 74% male) Transient and focal attacks of cerebral ischaemia lasting less than 24 hours and leaving no deficit. Diagnosis was based upon internationally accepted criteria by two physicians, if no agreement could be made at least one more neurologist was consulted.

Independent blinded reference standard, applied in ?all patients from a ?consecutive inappropriate spectrum.
Diagnostic test: Holter monitoring for 24 hours. All dysrhythmias that were observed in the recordings were submitted for a blind review to a cardiologist.
  • The study was a retrospective case-control study of prevalence.
  • 100 age and sex matched controls were also selected.

The evidence


differential diagnosis number of patients prevalence
(95% CI)
atrial fibrillation or flutter definitely related to embolism in TIA patients 5 5.00%
(0.73% to 9.27%)
episodic sick sinus syndrome possibly related to embolism 32 32.0%
(22.9% to 41.1%)
bradyarrhythmia alone possibly related to embolism 18 18.0%
(10.5% to 25.5%)
bradytachyarrhythmia possibly related to embolism 14 14.0%
(7.20% to 20.8%)

  • Atrial fibrillation or flutter related to embolism occurred in 2 controls.
  • Epsodic sick sinus syndrome possibly related occurred in 13 controls.
  • Bradyarrhythmia alone possibly related occurred in 10 controls.
  • Bradytachyarrhythmia possibly related occurred in 3 controls.

Citation

  1. Koudstaal PJ, van Gijn J, Klootwijk APJ, et al: Holter monitoring in patients with transient and focal ischaemic attacks of the brain. Stroke 1986; 17 (2): 192-195
Contributor: Clare Wotton and Musab Hayatli, December 1999
Reviewer:

Clinical Question.
Patient transient and focal cerebral ischaemia
Intervention or Exposure Holter monitoring
Comparison
Outcome prevalence of dysrhythmias