Key result
Implantable cardiac monitors detect ~4-fold more AF at 6 months vs non-invasive ECG in TIA.
Why the study?
Effective stroke prevention after TIA requires identifying mechanisms like AF, but the appropriate extent and modality of cardiac monitoring are unknown.
Does an implantable cardiac monitor improve the detection rate of atrial fibrillation in TIA patients without known AF compared to 24-hour or 28-day non-invasive ECG monitoring?
RCT (n=516)
1:1:1
Yes
Does an implantable cardiac monitor improve the detection rate of atrial fibrillation in TIA patients without known AF compared to 24-hour or 28-day non-invasive ECG monitoring?
Absolute Event Rate: 14.6% vs 3.4%
In patients with a recent TIA, an implantable cardiac monitor significantly increases the detection of underlying atrial fibrillation compared to short-term or prolonged non-invasive ECG monitoring.
Supports ICM over 24h monitoring for post-stroke AF screening; confirms superior yield and extends evidence for prolonged rhythm surveillance.
Background and aims Effective stroke prevention in TIA patients depends on identifying underlying mechanisms including atrial fibrillation (AF). Currently, the appropriate extent and modality of cardiac monitoring for AF detection in TIA patients are unknown. We conducted an investigator-initiated trial comparing 3 methods of cardiac monitoring. Methods We randomly assigned, in a 1:1:1 ratio, TIA patients without known AF to receive either 24h Holter-ECG, 28d continuous non-invasive ECG monitoring or an implantable cardiac monitor (ICM; REVEAL-LINQ). Patients were enrolled within 30d of index TIA and followed-up for 24 months. The primary endpoint was AF detection rate (episodes >30sec) 6 months after enrollment. Pairwise comparisons between groups were sequentially tested at interim analysis (200 patients) and adapted for final analysis. Secondary endpoints included AF detection at 12 and 24 months. Clinical endpoints were adjudicated for exploratory analysis. Results 516 patients were enrolled by 27 German and Spanish sites. 504 patients started ECG monitoring. For the modified intention-to-treat analysis, 158 underwent ICM, 176 24h and 170 28d monitoring. Mean age was 69+/-10 years, 57% were male. At interim analysis and in the entire study population, AF was detected significantly more frequently in the ICM (15.6%; 14.6%) compared to the 24h (1.5%; 3.4%) and 28d (1.4%; 3.5%) groups. Secondary/exploratory outcomes are being analyzed. Conclusions In ODEA-TIA, the first RCT examining AF detection specifically in TIA patients, monitoring with ICM was superior to short-term and prolonged non-invasive ECG recording. The impact of more AF detection by ICM on clinical endpoints will be presented at ESOC. Conflict of interest
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Veltkamp et al. (2026) conducted an RCT in Transient Ischemic Attack (TIA) (n=516). Implantable cardiac monitor (ICM) vs. 24h Holter-ECG or 28d continuous non-invasive ECG monitoring was evaluated on AF detection rate (episodes >30sec) 6 months after enrollment. In TIA patients, an implantable cardiac monitor detected atrial fibrillation significantly more frequently at 6 months (14.6%) compared to 24h (3.4%) or 28d (3.5%) non-invasive ECG monitoring.
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