A Prospective Study on Clinical Profile and the Utility of 72-h Holter Monitoring in Acute Ischaemic Stroke and...

Atrial fibrillation (AF) is a major cause of recurrent ischaemic stroke, yet detection after acute events is often suboptimal, particularly in resource-limited settings.

This study aims to assess the clinical profile and the utility of 72-h Holter monitoring in determining AF and other cardiac arrhythmias in acute ischaemic stroke and transient ischaemic attack (TIA) patients.

In this prospective observational study, 200 consecutive patients with acute ischaemic stroke/TIA underwent detailed clinical evaluation, laboratory profiling, neuroimaging, echocardiography and continuous electrocardiogram (ECG) monitoring (72-h Holter). Stroke subtyping followed trial of ORG 10172 in acute stroke treatment (TOAST) criteria. Predictors of newly detected AF were identified via univariate and multivariate logistic regression. Ethical approval was obtained, and informed consent was secured.

Among 200 patients with acute ischaemic stroke or TIA (mean age 63.9 ± 12.4 years; 69% male), 72-h Holter monitoring detected AF/flutter in 20.5%, with 70.7% of these showing clinically significant episodes (≥30 s). Other arrhythmias included supraventricular tachycardia (SVT) (12.5%), ventricular ectopics (16.0%) and atrioventricular (AV) block (4.5%). Holter findings led to treatment modification in 20%, primarily the initiation of anticoagulation. Compared with non-AF patients, those with AF were older (≥60 years: 90.2%, p = .002), had higher rates of diabetes (68.3%), hypertension (85.4%), chronic kidney disease (CKD) (43.9%) and left atrial enlargement (LAE) (29.2% vs 1.9%, p = .01). AF patients presented with higher median National Institutes of Health Stroke Scale (NIHSS) [8 vs 6, p = .04] and more severe infarcts, with posterior (48.8% vs 27.0%) and multi-territory (19.5% vs 5.3%) involvement. Independent predictors of AF included CKD (aOR 4.91), left atrium (LA) enlargement (aOR 5.18), multi-territory infarcts (aOR 12.35), posterior circulation infarcts (aOR 3.74) and tachycardia >100 bpm at admission (aOR 4.78).

72-hour Holter monitoring demonstrated high clinical utility in detecting AF and other clinically significant arrhythmias in acute ischaemic stroke and TIA patients, with direct therapeutic impact through timely initiation of anticoagulation. Importantly, the identification of SVT in 12.5% of patients, particularly those with a higher arrhythmic burden, highlights a potential preclinical substrate of atrial cardiopathy that may precede overt AF. These findings support the incorporation of extended Holter monitoring into post-stroke evaluation, especially for high-risk groups, both to optimise etiological classification and to enable personalised secondary prevention strategies that reduce the risk of recurrent cerebrovascular events.