Longer duration of electrocardiographic monitoring after cryptogenic stroke is associated with a greater detection of AF .
BACKGROUND Atrial fibrillation ( AF ) is a major cause of stroke .
Although st and ard investigations after an event include electrocardiographic monitoring , the optimal duration to detect AF is unclear .
We performed a systematic review and meta- analysis to determine whether the duration of electrocardiographic monitoring after an ischemic event is related to the detection of AF .
Pilot Randomized Trial of Outpatient Cardiac Monitoring After Cryptogenic Stroke
Background and Purpose — Observational studies indicate that outpatient cardiac monitoring detects previously undiagnosed atrial fibrillation ( AF ) in 5 % to 20 % of patients with recent stroke . However , it remains unknown whether the yield of monitoring exceeds that of routine clinical follow-up . Methods — In a pilot trial , we r and omly assigned 40 patients with cryptogenic ischemic stroke or high-risk transient ischemic attack to wear a Cardionet mobile cardiac outpatient telemetry monitor for 21 days or to receive routine follow-up alone . After thorough investigation , we excluded patients with documented AF or other apparent stroke pathogenesis . We contacted patients and their physicians at 3 months and at 1 year to ascertain any diagnoses of AF or recurrent stroke or transient ischemic attack . Results — The baseline characteristics of our cohort broadly matched those of previous observational studies of monitoring after stroke . In the monitoring group , patients wore monitors for 64 % of the assigned days , and 25 % of patients were not compliant at all with monitoring . No patient in either study arm received a diagnosis of AF . Cardiac monitoring revealed AF in zero patients ( 0 % ; 95 % confidence interval , 0%–17 % ) , brief episodes of atrial tachycardia in 2 patients ( 10 % ; 95 % confidence interval , 1%–32 % ) , and nonsustained ventricular tachycardia in 2 patients ( 10 % ; 95 % confidence interval , 1%–32 % ) . Conclusions — In the first reported r and omized trial of cardiac monitoring after cryptogenic stroke , the rate of AF detection was lower than expected , incidental arrhythmias were frequent , and compliance with monitoring was suboptimal . Our findings highlight the challenges of prospect ively identifying stroke patients at risk for harboring paroxysmal AF and ensuring adequate compliance with cardiac monitoring . Clinical Trial Registration — URL : http:// clinical trials.gov . Unique Identifier :
Longer duration of electrocardiographic monitoring after cryptogenic stroke is associated with a greater detection of AF .
BACKGROUND Atrial fibrillation ( AF ) is a major cause of stroke .
Although st and ard investigations after an event include electrocardiographic monitoring , the optimal duration to detect AF is unclear .
We performed a systematic review and meta- analysis to determine whether the duration of electrocardiographic monitoring after an ischemic event is related to the detection of AF .