Letter by Acampa et al Regarding Article, “Underutilization of Ambulatory ECG Monitoring After Stroke and Transient Ischemic Attack: Missed Opportunities for Atrial Fibrillation Detection”
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To the Editor:
We read with interest the article by Edwards et al.1 In their longitudinal cohort study, the authors found that less than one third of patients with stroke received a 24-hour Holter monitoring and <1% a prolonged ambulatory ECG monitoring.
As remarked in the paper, the lack of an appropriate ECG monitoring may lead to an underdiagnosis of atrial fibrillation (AF) and, consequently, to an overdiagnosis of cryptogenic strokes, resulting in missed anticoagulant treatment opportunities for secondary stroke prevention.
However, in common clinical practice, it is really difficult and expensive to perform ambulatory ECG monitoring in all ischemic stroke patients. For this reason, the need to identify subgroups of patients to submit to ambulatory ECG monitoring has important clinical implications for the detection of covert AF, especially in …