Aims Atrial fibrillation (AF) is a preventable cause of ischaemic stroke but it is often undiagnosed and undertreated. The utility of smartphone electrocardiogram (ECG) for the detection of AF after ischaemic stroke is unknown. The aim of this study is to determine the diagnostic yield of 30-day smartphone ECG recording compared with 24-h Holter monitoring for detecting AF ≥30 s. Methods and results In this multicentre, open-label study, we randomly assigned 203 participants to undergo one additional 24-h Holter monitoring (control group, n = 98) vs. 30-day smartphone ECG monitoring (intervention group, n = 105) using KardiaMobile (AliveCor®, Mountain View, CA, USA). Major inclusion criteria included age ≥55 years old, without known AF, and ischaemic stroke or transient ischaemic attack (TIA) within the preceding 12 months. Baseline characteristics were similar between the two groups. The index event was ischaemic stroke in 88.5% in the intervention group and 88.8% in the control group (P = 0.852). AF lasting ≥30 s was detected in 10 of 105 patients in the intervention group and 2 of 98 patients in the control group (9.5% vs. 2.0%; absolute difference 7.5%; P = 0.024). The number needed to screen to detect one AF was 13. After the 30-day smartphone monitoring, there was a significantly higher proportion of patients on oral anticoagulation therapy at 3 months compared with baseline in the intervention group (9.5% vs. 0%, P = 0.002). Conclusions Among patients ≥55 years of age with a recent cryptogenic stroke or TIA, 30-day smartphone ECG recording significantly improved the detection of AF when compared with the standard repeat 24-h Holter monitoring.

Information Classification: General compromise in care for a larger proportion of non-COVID-19 patients amid efforts against COVID-19 in a large non-COVID-designated hospital with hybrid status.

Stroke with AF is often associated with high recurrence rates. However, many patients with ischaemic stroke do not have a history of AF and show sinus rhythm and the absence of AF on their admission ECG. The detection of AF remains challenging due to its intermittent nature. Therefore, the ultimate goal of cardiac monitoring after cerebral ischaemic events is to detect AF so that oral anticoagulants can be prescribed to prevent the recurrence of a second, more debilitating or fatal stroke. In this article, AF detection in hospitalised patients with ischaemic stroke is discussed, with a focus on the Asian population. The AF detection rates in Asian cohorts are compared with those of major studies in the Western population; the utility and limitations of various cardiac monitoring modalities in Asian populations and healthcare systems and emerging technologies that could potentially detect AF in the stroke population are summarised and clinical practice and evidence gaps in detecting AF to prevent stroke recurrence are discussed.