Seemant Chaturvedi, MD reviewing Wachter R et al. Lancet Neurol 2017 Apr.

Ten-day Holter monitoring, repeated three times in 6 months, significantly increased detection.

Recent studies have found that in patients with stroke of unknown cause (cryptogenic stroke), extended poststroke monitoring detects intermitted atrial fibrillation (AF) in 5% to 20%. In this manufacturer-funded study, investigators from Germany randomized 400 patients (aged >60) to 10-day Holter monitor recordings at three time points following ischemic stroke (baseline, 3 months, and 6 months) or to standard monitoring (≥24-hour Holter or telemetry monitoring). Patients with severe, ipsilateral carotid or intracranial stenosis or prior AF diagnosis were excluded. The primary endpoint was detection of AF or atrial flutter lasting 30 seconds or longer.

At 6 months, 14% of patients in the extended-monitoring group had AF detected, significantly more than the 5% in the standard group (number needed to screen, 11). The median time from study enrollment to detection of AF was similar in both groups (33 days vs. 36 days). Among 25 patients with AF detected by prolonged monitoring, 18 were noted in the first Holter recording period, 6 in the second period, and 1 in the third. All patients with AF detection were offered oral anticoagulation.

CITATION(S):

Wachter R et al. Holter-electrocardiogram-monitoring in patients with acute ischaemic stroke (Find-AFRANDOMISED): An open-label randomised controlled trial. Lancet Neurol 2017 Apr; 16:282. 

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