Prolonged monitoring increases AF yield in stroke survivors

By Eleanor McDermid

Another presentation at the International Stroke Conference today shows that prolonged periods of Holter-ECG monitoring markedly increase detection of paroxysmal atrial fibrillation (AF) in patients with stroke.

In the Find-AFrandomised Trial, AF was detected in 13.5% of 200 stroke patients who underwent three 10-day periods of monitoring over 6 months, compared with just 4.5% of 198 patients given standard care, which included at least 24 hours of continuous monitoring.

This gave a number needed to screen of 11 to detect one patient with AF, according to researcher Rolf Wachter (University of Göttingen, Germany).

He noted that only about two-thirds of the patients underwent all scheduled 10-day periods of monitoring, meaning that the actual prevalence of AF may have been underestimated. However, he also cautioned that it is not clear if short periods of AF affect stroke risk and therefore if these patients should receive oral anticoagulation.

All study patients with newly detected AF were started on oral anticoagulation, amounting to 12.7% of participants in the prolonged monitoring group and 4.9% in the control group by 6 months.

By 12 months, 2.5% of patients in the monitoring group versus 5.1% of those in the control group had experienced a recurrent stroke. Although "numerically fewer" in the monitoring group, the difference was not statistically significant, said Wachter.

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