Detection of paroxysmal atrial fibrillation or flutter in patients with acute ischemic stroke or transient ischemic attack by Holter monitoring

Indian Heart J. Mar-Apr 2014;66(2):188-92. doi: 10.1016/j.ihj.2014.02.009. Epub 2014 Mar 4.


Background and purpose: Paroxysmal atrial fibrillation and flutter are strong risk factors for stroke. Due to high recurrence rate of ischemic events and given the benefit of oral anticoagulation over antiplatelet drugs, it is important to identify this arrhythmia. Unfortunately, paroxysmal AF or flutter is asymptomatic in majority and therefore, difficult to detect.

Methods: Consecutive patients presenting with symptoms of acute ischemic stroke or transient ischemic attack were included. All patients free of AF or flutter on presentation underwent 24 h Holter monitoring within 7 days of admission.

Results: Overall, fifty two (52) patients (mean age 59.51 ± 13.45 years) with acute stroke (80.8%) and TIA (19.8%) underwent 24 h Holter monitoring. Paroxysmal AF was detected in 3 cases (5.8%), all 3 patients had acute stroke and were older than age 60 years. Type of stroke was the only factor which was associated with greater risk of having paroxysmal AF or flutter, AF accounted for 50% cases (2 out of 4) of clinically suspected cardio embolic stroke.

Conclusion: Screening consecutive patients with ischemic stroke with routine Holter monitoring will identify new atrial fibrillation/flutter in approximately one in 17 patients. Older age and type of stroke are strongly associated with increased risk. By carefully selecting the patients, the detection rates could be further increased.

Keywords: Acute ischemic stroke; Atrial flutter; Holter monitoring; Paroxysmal atrial fibrillation; Transient ischemic attack.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Atrial Fibrillation / diagnosis*
  • Atrial Fibrillation / epidemiology
  • Atrial Flutter / diagnosis*
  • Atrial Flutter / epidemiology
  • Cohort Studies
  • Diagnosis, Differential
  • Electrocardiography, Ambulatory / methods*
  • Female
  • Follow-Up Studies
  • Hospitalization
  • Humans
  • Incidence
  • India
  • Ischemic Attack, Transient / diagnosis*
  • Ischemic Attack, Transient / epidemiology
  • Male
  • Middle Aged
  • Monitoring, Physiologic / methods
  • Prospective Studies
  • Risk Assessment
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Stroke / diagnosis*
  • Stroke / epidemiology
  • Tachycardia, Paroxysmal / diagnosis
  • Tachycardia, Paroxysmal / epidemiology