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(Chest. 1995;107:916-918.)
© 1995 American College of Chest Physicians

Is Ambulatory Electrocardiography Useful in the Evaluation of Patients With Recent Stroke?

Danielle K. Kessler 1 and Kenneth M. Kessler MD1

1 From the Division of Cardiology, Department of Medicine, University of Miami School of Medicine, and the Cardiology Section, Medical Service, Veterans Affairs Medical Center, Miami, Fla.

This study was designed to determine whether ambulatory electrocardiography in patients with recent stroke would lead to a change in clinical management or outcome and to express these findings in terms of cost benefit. A prospective, consecutive sample of patients (n=100) with recent stroke referred from the neurology or medical services for ambulatory electrocardiography was identified. Ambulatory electrocardiograms were reviewed to identify patients with potentially important bradyarrhythmias, tachyarrhythmias, or atrial fibrillation. Patients were then followed up without interference with ongoing care to determine whether these findings led to changes in clinical management that might influence patient outcome. Of the 100 patients, 16 had an index "important" arrhythmia. No significant bradyarrhythmias were noted. Nonsustained ventricular tachycardia (ge6 complexes) in two patients and supraventricular tachycardia (ge10 complexes) in seven patients did not lead to management changes. Four patients had a history of atrial fibrillation who were in sinus rhythm; anticoagulation had been addressed in three; the fourth patient died before the issue could be addressed. Of three patients in atrial fibrillation, there was a history of atrial fibrillation and a decision regarding anticoagulation in each before monitoring. The cost of these 100 ambulatory electrocardiograms was about $55,000. In conclusion, these findings do not support the routine use of ambulatory electrocardiography in the evaluation of patients with stroke.

Key Words: ambulatory electrocardiography • arrhythmia • atrial fibrillation • cost analysis • cost benefit • stroke

Submitted on March 28, 1994
Accepted on September 20, 2007




This article has been cited by other articles:


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J. Liao, Z. Khalid, C. Scallan, C. Morillo, and M. O'Donnell
Noninvasive Cardiac Monitoring for Detecting Paroxysmal Atrial Fibrillation or Flutter After Acute Ischemic Stroke: A Systematic Review
Stroke, November 1, 2007; 38(11): 2935 - 2940.
[Abstract] [Full Text] [PDF]


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Copyright © 1995 by the American College of Chest Physicians.