Improved screening for silent atrial fibrillation after ischaemic stroke

Area of Science:

• Cardiology
• Neurology

Background:

• Silent paroxysmal atrial fibrillation (AF) is a significant risk factor for ischemic stroke.
• The prevalence and optimal detection methods for silent AF in stroke patients remain unclear.

Purpose of the Study:

• To compare the effectiveness of brief intermittent long-term ECG recordings versus short-term continuous ECG monitoring in detecting silent AF in ischemic stroke patients.
• To establish the prevalence of silent AF in this patient population.

Main Methods:

• A study involving 249 ischemic stroke/transient ischemic attack (TIA) patients without known AF.
• Patients underwent 24-hour continuous ECG monitoring and performed 10-second rhythm registrations twice daily for 30 days using a hand-held ECG device.
• Intermittent ECG recordings were also triggered by arrhythmia symptoms.

Main Results:

• Atrial fibrillation (AF) was diagnosed in 17 patients (6.8% prevalence), increasing to 11.8% in those aged ≥75 years.
• Intermittent monitoring detected 108 AF episodes in 15 patients, significantly outperforming 24-hour Holter monitoring (P = 0.013).
• Two patients had AF detected exclusively by 24-hour Holter monitoring.

Conclusions:

• Prolonged, brief intermittent arrhythmia screening significantly enhances the detection of silent paroxysmal AF in recent ischemic stroke/TIA patients.
• This improved detection facilitates timely initiation of oral anticoagulant treatment, potentially reducing recurrent stroke risk.