Clinically important atrial arrhythmia and stroke risk: a UK-wide online survey among stroke physicians and cardiologists

Rankin, A.J. , Tran, R.T., Abdul-Rahim, A.H. , Rankin, A.C. and Lees, K.R. (2014) Clinically important atrial arrhythmia and stroke risk: a UK-wide online survey among stroke physicians and cardiologists. QJM: An International Journal of Medicine, 107(11), pp. 895-902. (doi: 10.1093/qjmed/hcu177)

Abstract

Background: A recording of ≥30 s is required for diagnosis of paroxysmal atrial fibrillation (AF) when using ambulatory electrocardiography (ECG) monitoring. It is unclear if shorter runs of atrial arrhythmia are relevant with regard to stroke risk.<p></p> Aim: To assess current management of patients with atrial arrhythmia of <30 s duration detected on ambulatory ECG.<p></p> Design: Online survey.<p></p> Methods: An online survey was sent to cardiologists and stroke physicians in the UK, via their national societies.<p></p> Results: A total of 205 clinicians responded to the survey (130 stroke physicians, 64 cardiologists, 11 other). Regarding diagnosis of AF, 87% of responders would accept a single 12-lead ECG. In contrast, only 45% would accept a single episode lasting <30 s detected on ambulatory monitoring. There was more agreement with regard to the decision to anticoagulate. When asked whether they would anticoagulate eight hypothetical patients with non-diagnostic paroxysms of AF, there was a mean agreement of responses of 78.6%, with up to 94.1% agreement for high-risk patients. There was a trend suggesting that stroke physicians were more likely to accept an atrial arrhythmia of <30 s as ‘AF’ than cardiology specialists [OR 1.63 (95% CI 0.88–3.01), P = 0.12].<p></p> Conclusions: There is a lack of consensus on the diagnosis and management of patients with brief runs of atrial arrhythmia detected on ambulatory ECG. Further research is needed to clarify the risk of stroke in this unique population of patients.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lees, Professor Kennedy and Rankin, Dr Alastair and Abdul-Rahim, Dr Azmil and Rankin, Mrs Aileen
• Authors: Rankin, A.J., Tran, R.T., Abdul-Rahim, A.H., Rankin, A.C., and Lees, K.R.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: QJM: An International Journal of Medicine
• Publisher: Oxford University Press
• ISSN: 1460-2725
• ISSN (Online): 1460-2393