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 .
Continuous Stroke Unit Electrocardiographic Monitoring Versus 24-Hour Holter Electrocardiography for Detection of Paroxysmal Atrial Fibrillation After Stroke
Background and Purpose — Cardioembolism in paroxysmal atrial fibrillation ( pxAF ) is a frequent cause of ischemic stroke . Sensitive detection of pxAF after stroke is crucial for adequate secondary stroke prevention ; the optimal diagnostic modality to detect pxAF on stroke units is unknown . We compared 24-hour Holter electrocardiography ( ECG ) with continuous stroke unit ECG monitoring ( CEM ) for pxAF detection . Methods — Patients with acute ischemic stroke or transient ischemic attack were prospect ively enrolled . After a 12-channel ECG on admission , all patients received 24-hour Holter ECG and CEM . Additionally , ECG monitoring data underwent automated analysis using dedicated software to identify pxAF . Patients with a history of atrial fibrillation or with atrial fibrillation on the admission ECG were excluded . Results — Four hundred ninety-six patients ( median age , 69 years ; 61.5 % male ) fulfilled all inclusion criteria ( ischemic stroke : 80.4 % ; transient ischemic attack : 19.6 % ) . Median stroke unit stay lasted 88.8 hours ( interquartile range , 65.0–122.0 ) .  ECG data  for automated CEM analysis were available for a median time of 64.0 hours ( 43.0–89.8 ) . Paroxysmal AF was documented in 41 of 496 patients ( 8.3 % ) . Of these , Holter detected pxAF in 34.1 % ; CEM in 65.9 % ; and automated CEM in 92.7 % . CEM and automated CEM detected significantly more patients with pxAF than Holter ( P<0.001 ) , and automated CEM detected more patients than CEM ( P<0.001 ) . Conclusions — Automated analysis of CEM improves pxAF detection in patients with stroke on stroke units compared with 24-hour Holter ECG . The comparative usefulness of prolonged or repetitive Holter ECG recordings requires further evaluation
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 .