Arrhythmia screening after stroke and transient ischaemic attack: early non-invasive detection of incidental significant arrhythmia

Abstract Background Significant and serious cardiac arrythmias are common post stroke, occurring in up to 25.1% of patients in the acute phase of stroke. These pose a risk of haemodynamic instability and cardiac death ref 1. Beyond this acute stroke period, cardiac rhythm monitoring strategies routinely focus on Atrial Fibrillation (AF) detection. Purpose The optimal approach for detecting significant non-AF cardiac arrhythmias, as well as their prevalence in the post-acute phase, remains unknown. We aimed to investigate this within our post-stroke/TIA patients AF detection pathway. Methods Our hospitals encompass three Acute Stroke units. Consecutive, unselected post-stroke and TIA patients received Zio 14-day cardiac monitoring for outpatient AF screening. 240 patients were further reviewed based on the detection of AF and/or other cardiac arrhythmias. Imaging and medical records were examined. Zio clinical data was extracted to determine arrhythmia findings. Results 1,044 patients between September 2022 to June 2024 were included with mean age of 70 years (range 17-100). 49 patients were diagnosed with AF alone, 21 had AF in conjunction with other significant arrhythmias and 170 were diagnosed with significant arrhythmias other than AF. Of 191 patients, 27 (14.2%) experienced multiple arrhythmias contributing to 219 total non-AF findings. Non-AF significant arrhythmia initiating a change in management was common occurring in 83 (8.0% of total cohort). The following interventions were recommended in patients with recorded diagnoses of other significant arrhythmias +/- AF. Of those requiring intervention, 25 (30.1%) required PPM/ICD, ILR in 14 (16.9%) and 44 (53.0%) had medication change as the sole intervention. In this group, 30 (36.0%) were first detected within 24hrs, 12 (14.5%) in 24-48hrs, 6 (7.2%) in 48-72hrs, 15 (18.1%) in 3-7days and 20 (24.1%) in 7-14 days. Of the patients indicating a change in management, only 2 had corroborated a triggered symptomatic event relating to the specific arrhythmia. Conclusion Zio monitors had a high diagnostic yield (8.0%) in non-AF arrhythmia requiring intervention in our post-stroke cohort which is similar to rates of AF detection necessitating anticoagulation in the same cohort (6.7%). A high proportion (45.6%) of arrhythmias were detected after 72 hours with 1:5 beyond 7 days. For findings requiring a change in management 35 (42.2%) were outside what would have been captured in a 3-day recording and 20 (24.1%) beyond 7-days. Almost all significant arrhythmia was asymptomatic, outlining the importance of an optimal post-stroke arrythmia detection strategy that is effective beyond AF. Early non-invasive extended monitoring with ZIO was highly effective for both significant arrythmia and AF detection.Figure 1.First Occurrence Arrhythmia Fi Figure 2.Zio Monitor Arrhythmia Finding