Apport du Holter ECG dans le bilan étiologique des infarctus cérébraux à Brazzaville, Congo

To determine the prevalence of the rhythmic disorders during ischemic stroke, and to identify the predictive factors of paroxysmal atrial fibrillation (PAF). It was about a cross-sectional study, descriptive and analytical, conducted to Brazzaville between january 2012 and december 2016. It related to a consecutive series of 267 patients victims of a transient ischemic attack (n = 17) or ischemic stroke (n = 250), documented by cerebral tomodensitometry or brain MRI. All these patients profited from a recording 24h Holter ECG, carried out within the framework of etiologic research. The principal recorded rhythmic anomalies were indexed and the logistic regression allowed the identification of the predictive factors of PAF. They were 164 men (61.4%) and 103 women (38.6%), old on average of 60.2 ± 12.1 years. The identified cardiovascular risk factors were hypertension (80.1%), diabetes (13.5%), and tobacco use (6.7%). The 24h Holter ECG, normal in 216 cases (81%), was pathological in 51 cases (19%). The principal recorded anomalies consisted into ventricular ectopic beats (n = 32), PAF (n = 7), supraventricular ectopic beats (n = 5), non-sustained ventricular tachycardia (n = 4), sustained ventricular tachycardia (n = 2), and type 2 atrio-ventricular block (n = 1). The frequency of PAF was 2.6%. In bivariate analysis, it was not noted correlation between PAF and sex (p = 0.55), hypertension (p = 0.42), diabetes (p = 0.64), and tobacco use (p = 0.61). In multivariate analysis, only the age was the predictive factor of PAF during ischemic stroke (p = 0.0134). It comes out from this preliminary study that the emboligenous arrhythmias are relatively rare during ischemic stroke in Brazzaville. PAF, though little attends, remains primarily correlated at the age. Its systematic research at the old subjects contributes to improve the assumption of responsibility.