การศึกษาเปรียบเทียบการใช้ Continuous Electrocardiographic Monitoring กับ Holter Monitoring เพื่อตรวจหาภาวะหัวใจเต้นผิดจังหวะชนิด atrial fibrillation ในโรคหลอดเลือดสมองตีบและอุดตันระยะเฉียบพลัน

Duangpol Srimanee

Authors

Duangpol Srimanee Department of Internal Medicine, Nakhon Pathom Hospital, Nakhon Pathom

Keywords:

Continuous Electrocardiographic Monitoring (CEM), Holter monitoring, Atrial fibrillation (AF), Acute ischemic stroke

Abstract

Background: Paroxysmal atrial fibrillation (AF) is an important cause of acute ischemic stroke. Although Holter monitoring is the standard diagnostic modality, its use is limited by device availability and short monitoring duration. Continuous electrocardiographic monitoring (CEM), widely implemented in stroke units, may provide a practical alternative in general hospital settings. Methods: This prospective cohort study with historical controls included patients aged >65 years with acute ischemic stroke admitted to the Stroke Unit of Nakhon Pathom Hospital from January 2019 to December 2024. AF detection rates between CEM and Holter monitoring were compared. All patients were followed continuously for AF occurrence and thromboembolic event for 1 year after the index stroke. Results: AF detection rates did not differ significantly between CEM and Holter monitoring. Factors associated with Higher AF detection included cardioembolism (OR 20.69; 95% CI 2.65–161.74; p = 0.006) and CHA₂DS₂-VASc score >5 (OR 5.72; 95% CI 0.82–39.81; p = 0.045). The cost per AF detected was substantially lower with CEM (2,067.7 THB) compared with Holter monitoring (32,800 THB). One-year follow-up identified 1 new AF case, 4 recurrent strokes, and 9 deaths. Conclusion: CEM Provided AF detection performance comparable to Holter monitoring while demonstrating superior markedly greater cost-effectiveness, particularly among high-risk groups such as patient with cardioembolism/ESUS or elevated CHA₂DS₂-VASc scores. These findings support CEM as a practical and efficient approach for AF surveillance in routine stroke unit care

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