Continuous 4‐week ECG monitoring with adhesive electrodes reveals AF in patients with recent embolic stroke of undetermined source

Abstract

BackgroundAtrial fibrillation (AF) frequently escapes routine stroke workup due to its unpredictable and often asymptomatic nature, leaving a significant portion of patients at high risk of recurrent stroke. Recent trials emphasized continuous electrocardiogram (ECG) monitoring in the detection of occult AF. We screened AF in patients meeting the embolic stroke of unknown source (ESUS) criteria using an external miniaturized recorder with an adhesive electrode.MethodsPatients aged ≥50 with recent ESUS were prospectively screened and assigned to wear a 1‐lead ECG device capable to record continuous ECG for up to 4 weeks. Electrodes were replaced every 3–4 days. Primary outcome was proportion of patients completing at least 80% of monitoring. Secondary outcome measures included incidence of AF and initiation of oral anticoagulation therapy after AF detection.ResultsFifty‐seven patients were monitored (mean age 64.5 ± 8.2 years, median delay from stroke to the start of monitoring 8 days, IQR 4–44). Of these, 51 patients (89.5%) completed at least 80% of the desired monitoring period. We detected AF ≥30 s in seven patients (12.3%), all of whom initiated anticoagulation therapy. Atrial fibrillation was revealed in six patients (85.7%) within the first week of monitoring. Compared to patients without AF, patients with AF were older (70.6 ± 5.1 vs. 63.6 ± 8.3 years, p < 0.011) and more obese (body mass index 30.0 ± 3.4 vs. 26.6 ± 4.6, p < 0.039).ConclusionsProlonged ECG monitoring with an external device using adhesive electrodes is feasible in ESUS patients, since nine out of ten patients used the device appropriately and AF was detected in one out of eight patients.

Prolonged ECG with a novel recorder utilizing electrode belt and mobile device in patients with recent embolic stroke of undetermined source: A pilot study

“…In our previous study, we detected pAF in 12% of the patients in a 4-week monitoring (Lumikari et al, 2019), which was in accordance with prior studies of 1-to 4-week monitoring periods (Sposato et al, 2015). The low pAF detection rate in the present patients (6.7%) was most probably caused by the relatively low age of our patients and limited sample size.…”

“…The EMBRACE study demonstrated a drastic increase in pAF detection rates using a 30‐day ECG monitor with belt, and multiple studies have afterward provided similar results with either plaster electrodes, wearable ECG, or implantable loop recorders (Gladstone et al., 2014; Israel et al., 2017; Sanna et al., 2014; Wachter et al., 2017). To the best of our knowledge, there are only two studies specifically focusing on ESUS patients with noninvasive monitoring methods, reporting detection rates of 22% in 21‐day monitoring (Rubio Campal et al., 2020) and 12% in 28‐day monitoring (Lumikari et al., 2019).…”

Diagnostic yield of chest and thumb ECG after cryptogenic stroke, Transient ECG Assessment in Stroke Evaluation (TEASE): an observational trial

“…In patients not eligible for thumb ECG, a device with adhesive electrodes would be an alternative. 35 Although a thumb ECG is an attractive method of non-invasive AF detection, there remain some controversies with regard to anticoagulation for short-term AF. The duration of an AF episode captured by snapshot is unknown, but it is assumed to represent longer or multiple episodes.…”

Usability of Wireless ECG Body Sensor for Cardiac Function Monitoring During Field Testing

“…On the other hand, it was proven that long term ECG monitoring during regular daily activities can be very useful in the detection of heart disease in people who had normal 12-lead ECG, and negative Master two-step tests [16]. Furthermore, it was proven that it is possible to detect atrial fibrillation in asymptomatic people with long-term one-channel ECG monitoring [17].…”