Impact of long-term ECG recording on the detection of paroxysmal atrial fibrillation in patients after an acute ischemic stroke.

An ECG recording time of 24 hours has a low yield to detect atrial arrhythmias in patients after an acute ischemic stroke. The present study investigated whether a recording time of 72 instead of 24 hours detects paroxysmal atrial fibrillation in more patients. The study prospectively included 82 consecutive patients 2-3 weeks after an acute ischemic stroke. All patients had sinus rhythm in the resting ECGs and no history of atrial fibrillation or flutter. The frequency of atrial fibrillation was assessed after 24, 48, and 72 hours of ambulatory ECG monitoring. An ECG monitoring time of 72 hours documented paroxysmal atrial fibrillation in five (6%) patients. The episode of paroxysmal atrial fibrillation occurred in only one patient within 24 hours. The other patients had their first episode of atrial fibrillation between 24 and 48 hours (n = 2) and between 48 and 72 hours (n = 2). These five patients were older (age = 70 +/- 5 years), whereas the mean age of the remaining patients was 59 +/- 13 years. All five patients had cardiovascular disease in comparison to 36 of 77 patients and reported palpitations in comparison to 6 of 77 of the remaining patients. In conclusion, ambulatory ECG monitoring over 72 hours detected after the first recording day four of five patients in whom paroxysmal atrial fibrillation could be documented for the first time. The 72-hour recording time improved, compared to the 24-hour period, the detection of paroxysmal atrial fibrillation in patients after an ischemic stroke. It seems to be more efficient to perform prolonged ECG recording mainly in older patients with a cardiovascular disease and/or a history of palpitations.