Published Online
on May 20, 2004

A more recent version of this article appeared on July 1, 2004

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Submitted on December 26, 2003
Revised on March 29, 2004
Accepted on March 31, 2004

Usefulness of Ambulatory 7-Day ECG Monitoring for the Detection of Atrial Fibrillation and Flutter After Acute Stroke and Transient Ischemic Attack

Denis Jabaudon MD, PhD^*; Juan Sztajzel MD; Katia Sievert;; Theodor Landis MD; and Roman Sztajzel MD

From the Department of Neurology (D.J, T.L, R.S.) and Cardiology Center, Department of Internal Medicine, (J.S., K.S.), University Hospital Geneva, Geneva, Switzerland.

^* To whom correspondence should be addressed. E-mail: denis.jabaudon{at}hcuge.ch.

Background and Purpose--Although atrial fibrillation (AF) is the most frequent cause of cardioembolic stroke, this arrhythmia remains underdiagnosed, as it is often asymptomatic or intermittent and, thus, may not be detected on standard 12-lead ECG or even 24-hour ECG recording (Holter). In this study, we hypothesized that 7-day ambulatory ECG monitoring using an event-loop recording (ELR) device would detect otherwise occult AF episodes after acute stroke or transient ischemic attack (TIA).

Methods--One hundred forty-nine consecutive patients admitted to our neurology department with an acute stroke or TIA were systematically screened for emboligenic arrhythmias using standard ECG. In the absence of AF on standard ECG, patients underwent 24-hour ECG recording (Holter), which was followed by a 7-day ambulatory ECG monitoring (ELR) in patients with a normal Holter. Patients with previously documented persistent AF, with primary hemorrhagic stroke, or with acute large vessel dissection were not included in the study.

Results--AF was detected in 22 patients. Standard ECG identified AF in 2.7% of the cases at admission (4/149 patients) and in 4.1% of remaining patients within 5 days (6/145). Holter disclosed AF in 5% of patients with a normal standard ECG (7/139 patients), whereas ELR detected AF in 5.7% of patients with a normal standard ECG and normal Holter (5/88 patients).

Conclusions--Following acute stroke or TIA, ELR identified patients with AF, which remained undetected with standard ECG and with Holter. ELR should, therefore, be considered in every patient in whom a cardioembolic mechanism is suspected.

Key words: atrial fibrillation • diagnostic tests • electrocardiography • prevention and control • stroke, cardioembolic

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