Detecting Paroxysmal Atrial Fibrillation After Ischemic Stroke and Transient Ischemic Attack: If You Don’t Look, You Won’t Find
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To the Editor:
Paroxysmal atrial fibrillation (AF) is a major preventable cause of stroke worldwide. We congratulate Liao and colleagues for their systematic review of a series of cohort studies highlighting the important issue of screening for occult AF after ischemic stroke and transient ischemic attack (TIA).1 As their review indicates, extended duration ECG monitoring after stroke/TIA identifies more patients with AF than standard ECG and Holter monitoring alone.
Short duration monitoring (24- to 72-hour Holter) identifies new AF in only about 5% of patients poststroke.1 Longer monitoring (4- or 7-day event loop recorder) detects new AF in an additional 6% to 8% of patients after a nondiagnostic Holter.1 Repeated monitoring detects even more. The incremental yield of serial monitoring was demonstrated in recent …