Diagnostic of atrial fibrillation on patients at TIA-clinic

Atrial fibrillation (AF) occurs mainly at higher age and is attended with a
higher chance of cardioembolic Cerebro Vasculair Accident (CVA) or Transient
IschaemicAttack (TIA). In the Netherlands more than 45.000 people annual get a
CVA or TIA, what are radical consequences for the patient and his environment.
Of this group of patients 25% die within a month, mostly because of a
cardiovascular disorder and 19% restrain severe constraints in daily
activity.
They expect the prevelation of AF will increase the next following years, on
the one hand because of the (double) aggiing of the population, on the other
hand because more patients survive a former fatal heartdisease.. This last
group of patients develop complications like AF.

AF can present permanent (persistent of permanent atrial ibrillation) or
present in episodes (paroxysmal atrial fibrillation). There is no difference in
risk of an ischaemic stroke between the several types of atrial fibrillation.
AF leads to a irregular heartbeat what is often underdiagnosed. AF can only be
diagnosed at the time of apperance bij registration of the heartrithm via an
electrocardiogram (ECG) or holterregistration. Paroxysmal atrial fibrillation
is therefore often underdiagnosed.

Patients with CVA or TIA and AF receive according to the current guidelines
(CHADs2-score) vitamin-K-antagonists (like acenocoumarol). As the diagnose will
be missed, this group of patients, will have an increased chance of a relapse
CVA or TIA. The ischaemic attack in patients with AF is in general more severe
than in patients without AF, probably because of the size of the emolism of
the left atrial. That's why correct diagnostic of AF in patients with CVA or
TIA is important.

Analysis of practice and literature have identified that long term registration
of heartritm is essential in diagnostic of mainly paroxysmal atrial
fibrillation. AF occurs in patients with CVA or TIA with left ventricle
hypertrophy, with left atrial enlargement, premature heartbeats with a
frequency of > 70 beats per minute. Beside that, AF occurs in patients with CVA
or TIA with cerebral ischemia in several flow area, with hyperthyreoïdie and in
patients with signs and symptoms like palpitations, short of breath, dizziness
and chest pain.

To identify that fysical complaints fitting with atrial fibrillation,
hyperthyroïdie, left atrial enlargment at ECG, left ventrikel hypertrophy at
ECG, premature atrial complex (with heartbeat > 70 bpm) at ECG and cerebral
ischemic attacks in several flow area are independent predictors of atrial
fibrillation.
Besides, to offer a correct diagnostic procedure of atrial fibrilation, so
that, after adjusting medication, the chance of a relapse CVA or TIA will be
decreased.

The TIA-AF-project is a defined diagnostic study at the diagnosis atrial
fibrillation. It is a cross-sectional design by which the diagnosis atrial
fibrillation is determined by a cardiologist.

The patient will be directed to the outpatient clinic cardiology for
diagnostic: fast-diagnostic-clinic (rapid access) atrial fibrillation. This
care is existing. What in this study will be used, is a 7-days
holterregistration instead of a 24-hours holterregistration. A 7-days
holterregistration is no common care, though is already used if the
cardiologist suspect atrial fibrillation, but is not (yet) detected at a
24-hours holterregistration.
The 7-days holterregistration is more aggravating for the patient than a
24-hours holterregistration, but the strain is light and has no or slight
risks. During the holterregistration the patient can not take a shower; but the
patient can switch off and on the holter by himself, if the patient likes to
take a shower.
The patient will be directed to the outpatient clinic cardiology for
fast-diagnostic, at which the patient in one day receive all diagnostic medical
examinations and results. Before starting this project the patient was directed
to the cardiologist (at suspicion of a cardiac embolic source), by which the
patient had to go to outpatient clinic several times for diagnostic medical
examinations and results. In this project the patient will be aggravated less.