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Updated: Apr 27, 2026

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Atrial fibrillation in patients with cryptogenic stroke.
David J Gladstone1, Melanie Spring, Paul Dorian
1From the Division of Neurology (D.J.G.), Department of Medicine (D.J.G., P.D., A.L., M.S., J.A.B., L.K.C., D.S., M. Mehdiratta, K.B., M.K.K.), and Dalla Lana School of Public Health (K.E.T.), University of Toronto, the University of Toronto Stroke Program (D.J.G.), Division of Neurology, Department of Medicine, and Brain Sciences Program, Sunnybrook Health Sciences Centre and Sunnybrook Research Institute (D.J.G., R.A.), the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery (D.J.G.), and the Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital (V.P., K.E.T., J.H., H.V., A.L., M. Mamdani), Toronto, McMaster University, Hamilton, ON (M.S., D.J.S.), McGill University, Montreal (R.C.), University of Alberta, Edmonton (A.S., B.B.), Western University, London, ON (V.H., J.D.S.), Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), University of British Columbia, Vancouver (P.T., S.Y.), Queen's University, Kingston, ON (A.J.), Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON (D.H.), Université Laval, Quebec City (S.V.), and Vancouver Island Health Research Centre, Victoria, BC (A.P.) - all in Canada; and the National University of Ireland, Galway (M.O.).
Extended ECG monitoring significantly increases the detection of paroxysmal atrial fibrillation (AF) in stroke patients. This leads to a higher rate of anticoagulant treatment, improving stroke prevention.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Atrial fibrillation (AF) is a major cause of preventable stroke.
- Paroxysmal AF often goes undetected in patients with ischemic stroke or TIA.
- Early detection and treatment of AF are critical for stroke prevention.
Purpose of the Study:
- To evaluate the effectiveness of extended noninvasive ambulatory ECG monitoring for detecting paroxysmal AF in patients with cryptogenic stroke or TIA.
- To compare the detection rates of AF and subsequent anticoagulation treatment between a 30-day event-triggered recorder and a conventional 24-hour monitor.
Main Methods:
- 572 patients aged 55+ with recent cryptogenic stroke/TIA underwent randomization.
- Intervention group: 30-day ambulatory ECG monitoring.
- Control group: conventional 24-hour ECG monitoring.
Main Results:
- Newly detected AF (≥30 seconds) occurred in 16.1% (intervention) vs. 3.2% (control) (P<0.001).
- Longer AF episodes (≥2.5 minutes) detected in 9.9% (intervention) vs. 2.5% (control) (P<0.001).
- Anticoagulant therapy prescribed more in the intervention group (18.6%) vs. control (11.1%) (P=0.01).
Conclusions:
- Paroxysmal AF is common in older patients with recent cryptogenic stroke/TIA.
- 30-day ambulatory ECG monitoring significantly increases AF detection (>5x) compared to standard monitoring.
- Extended monitoring nearly doubled the rate of anticoagulant treatment initiation.
Related Concept Videos
Hemorrhagic Stroke ll: Pathophysiology
Ischemic Stroke l: Introduction
ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
Ischemic Stroke ll: Pathophysiology
Transient Ischemic Attack l: Introduction
Hemorrhagic Stroke l: Introduction

