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 .
Improved Detection of Silent Atrial Fibrillation Using 72-Hour Holter ECG in Patients With Ischemic Stroke: A Prospective Multicenter Cohort Study
Background and Purpose — Adequate diagnosis of atrial fibrillation ( AF ) , including paroxysmal AF , is an important part of stroke workup . Prolonged ECG monitoring may improve the detection of paroxysmal , previously undiagnosed AF ( unknown AF ) . Therefore , we evaluated systematic 72-hour Holter ECG monitoring to detect unknown AF for the workup of patients with stroke . Methods — Unselected survivors of a stroke or transient ischemic attack ( TIA ) without known AF were enrolled in a prospect i ve , multicenter cohort study of 72-hour Holter ECG monitoring in 9 German secondary and tertiary stroke centers between May 2010 and January 2011 . In addition to st and ardized workup of stroke pathogenesis according to the German Stroke Unit protocol , all patients underwent 72-hour Holter ECG monitoring directly after admission . All ECGs were central ly analyzed by 2 independent observers . We determined the proportion of unknown AF and compared the detection rates of 72- and 24-hour monitoring . Results — A total of 1135 patients were enrolled ( mean age , 67 years [ SD , 13.1 years ] , 45 % women , 29 % TIA ) .  Unknown AF was detected in 49 out of 1135 patients ( 4.3 % , [ 95 % confidence interval , 3.4–5.2 % ] ) by 72-hour ECG monitoring .  Unknown AF was diagnosed in 29 patients ( 2.6 % ) within the first 24 hours of ECG monitoring , and in 20 more patients only by 72 hours of ECG monitoring . The number needed to screen by 72-hour ECG was 55 patients ( 95 % confidence interval [ 35–123 ] ) for each additional AF diagnosis . Patients with unknown AF were significantly older and had more often a history of previous stroke . Patients with unknown AF were equally distributed within categories of pathogenesis according to Trial of Org 10172 in Acute Stroke Treatment ( TOAST ) classification . Conclusions — In unselected survivors of stroke or TIA , 72-hour ECG monitoring is feasible and improves the detection rate of silent paroxysmal AF
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 .