Stroke is usually called “stroke”, which is the second largest cause of death in the world, second only to cardiovascular disease (CVD). But in our country, strokes are the primary causes of residents’ death and disability. The stroke has the characteristics of high incidence, high mortality, high disability rate, and high recurrence rate. According to statistics, at least one of each of the five deceased in my country died in stroke!
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Data show that the recurrence rate of patients with strokes in my country is 17.1%within one year, and the recurrence rate within 5 years is 33%. Among them, atrial fibrillation is an important “behind -the -scenes promoter” of a quiet stroke. In fact, the incidence of stroke in patients with atrial fibrillation is as high as 13%to 24%. If high blood pressure and diabetes are combined, the risk of stroke in patients with atrial fibrillation is as high as 30%.
Atrial fibrillation is one of the most common types of heart rhythms in the clinic, with more than 30 million patients around the world and about 8 million patients in China. The disease is characterized by high mortality and high residual rate, which is the most common cause of heart -based stroke. Patients with non -valve atrial fibrillation occur at the risk of stroke at a stroke of about 5 times that of atrial fibrillation. According to statistics, 76%of patients with heart -based stroke are accompanied by atrial fibrillation.
ECG monitoring can improve the detection of hidden atrial fibrillation of stroke survivors. With the development of medical technology, the implantation cycle recorder (ILR) is a small device (usually the size of the USB thumb drive) is increasingly used in clinical. ILR can be implanted under the skin of the left chest of the sternum, which can be used as a continuous ECG recorder to capture any abnormal heart rhythm. Because the equipment has two to three years of battery use time, long -term and continuous monitoring can be performed, so that heart disease experts have sufficient opportunities to capture any abnormal heart rhythm.
However, the monitoring effect of more atrial fibrillation compared to ischemic stroke compared to ischemic strokes compared with the traditional external cycle ECG. In order to explore this issue, neurological experts from the University of Alberta, Canada carried out relevant research, and published it on the latest “American Medical Society Magazine” Jama.
All participants were randomly assigned to ILR (n = 150) or external ECG (n = 150) for long -term ECG monitoring, and followed up in 30 days, 6 months, and 12 months. The main result is a clear atrial fibrillation or high -level atrial fibrillation. There are eight pre -designated results, including the analysis of events of new atrial fibrillation, recurrence ischemic stroke, internal bleeding, death, and equipment related to equipment within 12 months.
Among 300 patients who were randomly treated (medium age, 64.1 years old; 121 women [40.3%]; and 66.3%stroke that had not determined the cause), 273 (91.0%) completed ≥ 24 hours. Heart monitoring, 259 people (86.3%) completed the specified monitoring and follow -up in December.
In general, patients with 15.3%(23/150) in the implant ILR group observe the main results, while patients with 4.7%(7/150) in the external ECG group observe the main results (differences between the group = 10.7%) , RR = 3.29), it can be seen that the ILR detection rate is 3.29 times that of ECG. Of the eight specified secondary results, there are no obvious differences.
At the same time, 5 patients (3.3%) of ILR groups (3.3%) recur arechemic strokes, while 8 patients (5.3%) in the ECG group (5.3%) (differences between groups = -2.0%), and both (0.7%) patients in both groups (0.7%) patients Cerebral bleeding (differences between groups = 0%), 3 (2.0%) patients with deaths (differences between groups = 0%), and serious adverse events related to equipment related to 1 (0.7%) and 0 (0%).
It can be seen that among patients with ischemic stroke and no evidence of atrial fibrillation, the implantation ECG monitoring is 12 months. Compared with long -term external monitoring 30 days, the proportion of patients who detected atrial fibrillation within 12 months are obviously even more obviously more even more. high. Therefore, the implanted ECG map can better prevent secondary prevention for patients with stroke.
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Effect of Implantable vs Prolonged External Electrocardiographic Monitoring on Atrial Fibrillation Detection in Patients With Ischemic Stroke The PER DIEM Randomized Clinical Trial. JAMA. 2021;325(21)：2160–2168. doi：10.1001/jama.2021.6128