Optimizing cardiac monitoring strategies: patient characteristics associated with different methods of atrial fibrillation detection after stroke

Introduction A variety of cardiac monitoring strategies are currently available, including patch-type monitoring devices and implantable loop recorders (ILR). Identifying patient characteristics associated with atrial fibrillation (AF) detection through different monitoring methods may help inform cardiac monitoring strategies in embolic stroke of undetermined source (ESUS). Methods Patients with ESUS who were subsequently diagnosed with AF through continuous stroke-unit electrocardiography monitoring (CEM), Holter monitoring, or ILR were included in the study. Patients were categorized into two groups: short-term monitoring (CEM and Holter monitoring) and long-term monitoring (ILR). Factors associated with the detection of AF through short-term monitoring were investigated. Results Among 182 patients with ESUS who were newly diagnosed with AF, AF was detected through CEM ( n = 92, 50.5%), Holter monitoring ( n = 67, 36.8%), and ILR ( n = 23, 12.6%). The prevalence of diabetes was significantly different (40.2% vs. 16.4% vs. 56.5%, p < 0.001), while the left atrial diameter (LAD) showed a trend toward significance (41.4 ± 5.9 mm vs. 42.3 ± 6.6 mm vs. 38.4 ± 5.8 mm, p = 0.07). Multivariable analysis indicated that diabetes (odds ratio 0.23, 95% confidence interval 0.08–0.63, p = 0.004), current smoking (0.29, 0.11–0.79, p = 0.015), LAD (1.14, 1.04–1.25, p = 0.005), and white blood cell (WBC) count (1.34, 1.07–1.68; p = 0.011) were independently associated with the detection of AF through short-term monitoring. Discussion Patients with ESUS who have large LAD or elevated WBC counts were more likely to have AF detected during short-term monitoring compared to ILR. Patch-type monitoring devices may be an alternative for these patients prior to the use of ILR.