Gapless Electrocardiogram‐Monitoring in stroke at high risk of atrial fibrillation

Abstract

AbstractBackground and purposePrevious studies investigating prolonged electrocardiogram (ECG)‐monitoring after ischemic stroke had significant gaps between the index event and the beginning of long‐term monitoring. Atrial fibrillation (AF) detection might be higher if prolonged cardiac rhythm documentation is performed with a gapless approach without any interruption of monitoring time.MethodsThis investigator‐initiated, prospective study included patients with acute ischemic stroke or transient ischemic attack at three study centers. Participants received gapless ECG‐monitoring via telemetry during stroke‐unit admission until implantation of an insertable cardiac monitor (ICM) within the first days after the index event. Patients acted as their own controls and also received standard 24–72‐h Holter ECG.ResultsA total of 110 patients were included, of whom 86 (78.2%) had an embolic stroke of unknown source, 14 (12.7%) had small‐vessel disease, and 10 (9.1%) had large‐artery disease. AF was newly diagnosed in 17 (15.5%) patients via ICM monitoring, compared to one (0.9%) patient via Holter ECG during 6 months of follow‐up (p < 0.001). The detection rate of AF within the first 30 days was 10.0%, which accounted for 64% of all new AF diagnoses. The median duration of the detected episodes was 1.7 (interquartile range = 0.2–4.7) h. All patients with new onset AF were treated with oral anticoagulation.ConclusionsGapless ECG‐monitoring is an effective strategy to significantly increase the detection rate of AF after ischemic stroke. This finding supports the use of long‐term ECG‐monitoring with a gapless approach without any interruption in monitoring time as the gold standard for clinical practice.