ABSTRACT
Background: Approximately 25% of strokes are cryptogenic in origin and identifying atrial fibrillation (AF) as an etiologic factor in this situation has major therapeutic implication. Standard Holter ECG has a low sensitivity for AF detection in this patient group. Aim: To assess the diagnostic yield of prolonged ambulatory noninvasive ECG telemonitoring for AF detection in cryptogenic stroke or transitory ischemic attack (TIA) patients. Methods and Results: We prospectively included 36 patients (mean age 53 ± 15 years, 17% women) with cryptogenic stroke or TIA in the previous 3 months and without previously documented episodes of AF. We employed a validated ECG telemonitoring system (TEMEO). The median monitoring period was 22 days, ranging from 13 to 36 days. AF was detected in 10 patients (27%): in 7 patients (70%) AF episodes lasted <30 sec and in the other 3 episodes of absolute arrhythmia were longer. AF runs were asymptomatic in 6 of the patients with arrhythmia detection (60%). The mean time from initiation of telemonitoring to AF detection was 10 days, ranging from 2 to 29 days. Anticoagulation therapy for secondary prevention of stroke and systemic embolism was initiated in all of the patients with AF detected during telemonitoring. Conclusion: ECG telemonitoring after cryptogenic stroke or TIA results in AF detection in at least one in every four patients. Considering the important therapeutic implication of this finding we believe that prolonged ECG monitoring should become the standard of care in this patient group.