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 .
Enhanced Detection of Paroxysmal Atrial Fibrillation by Early and Prolonged Continuous Holter Monitoring in Patients With Cerebral Ischemia Presenting in Sinus Rhythm
Background and Purpose Diagnosis of paroxysmal atrial fibrillation is difficult but highly relevant in patients presenting with cerebral ischemia yet free from atrial fibrillation on admission . Early initiation and prolongation of continuous Holter monitoring may improve diagnostic yield compared with the st and ard of care including a 24-hour Holter recording . Methods — In the observational Find-AF trial ( IS RCT N 46104198 ) , consecutive patients presenting with symptoms of cerebral ischemia were included . Patients free from atrial fibrillation at presentation received  7-day Holter monitoring .  Results — Two hundred eighty-one patients were prospect ively included . Forty-four ( 15.7 % ) had atrial fibrillation documented by routine electrocardiogram on admission . All remaining patients received Holter monitors at a median of 5.5 hours after presentation . In those 224 patients who received Holter monitors but had no previously known paroxysmal atrial fibrillation , the detection rate with early and prolonged ( 7 days ) Holter monitoring  ( 12.5 % ) was significantly higher than for any 24-hour ( mean of 7 intervals : 4.8 % , P=0.015 ) or any 48-hour monitoring interval ( mean of 6 intervals : 6.4 % , P=0.023 ) . Of those 28 patients with new atrial fibrillation on Holter monitoring , 15 ( 6.7 % ) had been discharged without therapeutic anticoagulation after routine clinical care ( ie , with data from 24-hour Holter monitoring only ) . Detection rates were 43.8 % or 6.3 % for short supraventricular runs of ≥10 beats or prolonged episodes ( < 5 hours ) of atrial fibrillation , respectively . Diagnostic yield appeared to be only slightly and not significantly increased during the first 3 days after the index event . Conclusions — Prolongation of Holter monitoring in patients with symptoms of cerebral ischemic events increases the rate of detection of paroxysmal atrial fibrillation up to Day 7 , leading to a relevant change in therapy in a substantial number of patients . Early initiation of monitoring does not appear to be crucial . Hence , prolonged Holter monitoring ( ≥7 days ) should be considered for all patients with unexplained cerebral ischemia
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 .