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 .
Optimal timing and duration of continuous electrocardiographic monitoring for detecting atrial fibrillation in stroke patients.
BACKGROUND Several studies have suggested that after ischemic stroke , continuous electrocardiographic ( ECG ) monitoring ( CEM ) increases the atrial fibrillation ( AF ) detection rate . However , optimal CEM terms of use are not clear . The aim of our study was to evaluate the usefulness of CEM in detecting AF and define optimal terms of the use of CEM . METHODS We prospect ively enrolled consecutive patients with acute ischemic stroke who were admitted to the stroke unit without AF on baseline ECG . We compared 2 strategies of AF detection : the first using CEM and the second with routine clinical practice ( 24-hour Holter ECG and additional ECGs ) . Adjusted odds ratios for the association between AF diagnosis and the use of CEM stratified by monitoring duration were calculated using multivariate logistic regression analysis . RESULTS Of the 1166 patients included , 220 ( 18.87 % ) had AF on baseline ECG and were excluded . Of the 946 remaining patients , 592 underwent CEM . The prevalence of AF using CEM  was 12.50 % compared 2.26 % using the routine strategy . After adjustment ( demographic data , vascular risk factors , and National Institutes of Health Stroke Scale scores ) , using CEM increased 5.29 fold the odds of finding AF ( 95 % confidence interval [ CI ] 2.43 - 11.55 ) compared to the routine strategy . The adjusted odds ratio ( 9.82 ; 95 % CI 3.01 - 32.07 ) was maximum for the first day of monitoring and decreased later . Beyond 5 days ,  CEM usefulness was not significantly higher than the routine strategy . CONCLUSIONS We suggest that in order to enhance the detection rate of AF , CEM could be generalized in the stroke unit . It must be started early in patients with acute stroke and prolonged over a minimum of 4 days
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 .