Finding Atrial Fibrillation in Stroke - Evaluation of Enhanced and Prolonged Holter Monitoring

A Prospective, Randomised, Controlled Study to Determine the Detection of Atrial Fibrillation by Prolonged and Enhanced Holter Monitoring as Compared to Usual Care in Stroke Patients

The purpose of this study is to assess whether repeated enhanced and prolonged ECG monitoring after ischemic stroke results in a higher detection of atrial fibrillation (/flutter) compared to usual care (at least 24 hour of cardiac monitoring).

Inclusion Criteria:

• Recent cerebral ischemia defined as stroke (sudden focal neurologic deficit lasting > 24h consistent with the territory of a major cerebral artery and categorised as ischemic) and/or a corresponding lesion on brain imaging.
• Stroke symptoms started ≤ 7 days ago.
• Age ≥ 60 years.
• Modified Rankin scale ≤ 2 (prior to index event).

Exclusion Criteria:

• Known history of atrial fibrillation/flutter or atrial fibrillation/flutter on admission ECG.
• Indication for oral anticoagulation at randomisation.
• Absolute contra-indication against oral anticoagulation at randomisation.
• Intracerebral bleeding in medical history.
• Patient scheduled for Holter-ECG or cardiac Event-Recording monitoring ≥ 48 hours.
• Significant carotid artery or vertebral artery stenosis > 50% (NASCET classification), significant intracranial artery stenosis suspicious of atherosclerotic origin or acute arterial dissection explanatory of stroke symptoms.
• Implanted pacemaker device or cardioverter/defibrillator.
• Life expectancy < 1 year for reasons other than stroke (e.g. metastatic cancer).
• Concomitant participation in other controlled randomised trial.