BerndKallmuenzer, MD, Department of Neurology, University Medical Center, Erlangen, Germanybernd.kallmuenzer@uk-erlangen.de
Martin Koehrmann, Erlangen, Germany
Submitted September 04, 2014
We thank Dr. Totah for his comments and interest in our paper. Screening for AF by peripheral pulse palpation is recommended by international guidelines for patients 65 years or older to prevent ischemic stroke. [1] Among stroke survivors, the risk for paroxysmal AF is an expected 5 to 20 times higher than among cohorts of primary prevention and silent episodes are easily missed by single ECG diagnostics. [2] Before this study, it was unknown if peripheral pulse palpation technique was feasible and accurate among stroke survivors, possibly suffering from cognitive and sensomotoric handicaps.
In our study, patients were offered a training program that provided basic information on paroxysmal atrial fibrillation and cardioembolic stroke. Participants also took part in a tutorial on performing reliable pulse measurements at the radial artery. They were instructed to distinguish between absolute arrhythmic pulse sensation (indicative for paroxysmal AF) and regular peripheral pulse (indicative for a normal heart rhythm).
As Dr. Totah mentioned, the participants measured irregularities of the peripheral pulse at the radial artery and were thereby free to choose the side of measurement, depending on preexisting handicaps. This method could serve as a simple, non-invasive strategy to guide ECG diagnostics for secondary stroke prevention.
1. Camm AJ, Lip GY, De Caterina R, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 2012;33:2719-2747.
2. Rabinstein AA. Prolonged cardiac monitoring for detection of paroxysmal atrial fibrillation after cerebral ischemia. Stroke 2014;45:1208-1214.
For disclosures, please contact the editorial office at journal@neurology.org.
We thank Dr. Totah for his comments and interest in our paper. Screening for AF by peripheral pulse palpation is recommended by international guidelines for patients 65 years or older to prevent ischemic stroke. [1] Among stroke survivors, the risk for paroxysmal AF is an expected 5 to 20 times higher than among cohorts of primary prevention and silent episodes are easily missed by single ECG diagnostics. [2] Before this study, it was unknown if peripheral pulse palpation technique was feasible and accurate among stroke survivors, possibly suffering from cognitive and sensomotoric handicaps.
In our study, patients were offered a training program that provided basic information on paroxysmal atrial fibrillation and cardioembolic stroke. Participants also took part in a tutorial on performing reliable pulse measurements at the radial artery. They were instructed to distinguish between absolute arrhythmic pulse sensation (indicative for paroxysmal AF) and regular peripheral pulse (indicative for a normal heart rhythm).
As Dr. Totah mentioned, the participants measured irregularities of the peripheral pulse at the radial artery and were thereby free to choose the side of measurement, depending on preexisting handicaps. This method could serve as a simple, non-invasive strategy to guide ECG diagnostics for secondary stroke prevention.
1. Camm AJ, Lip GY, De Caterina R, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 2012;33:2719-2747.
2. Rabinstein AA. Prolonged cardiac monitoring for detection of paroxysmal atrial fibrillation after cerebral ischemia. Stroke 2014;45:1208-1214.
For disclosures, please contact the editorial office at journal@neurology.org.