Key result
Extended 72-hour Holter monitoring more than doubles SVT detection post-stroke to ~9% vs 24 hours.
Why the study?
Holter-ECG monitoring is routinely performed after a stroke or transient ischemic attack to detect atrial fibrillation, but the incidence and potential relevance of other unexpected ECG abnormalities had not been systematically assessed.
Does extended 72-hour Holter-ECG monitoring increase the detection of ECG abnormalities beyond atrial fibrillation compared to 24-hour monitoring in patients with acute ischemic stroke or TIA without known AF?
RCT (n=1,655)
Randomized
Yes
Does extended 72-hour Holter-ECG monitoring increase the detection of ECG abnormalities beyond atrial fibrillation compared to 24-hour monitoring in patients with acute ischemic stroke or TIA without known AF?
Post-stroke Holter-ECG monitoring identifies a high burden of supraventricular and ventricular arrhythmias beyond atrial fibrillation, with extended 72-hour monitoring increasing the diagnostic yield across all arrhythmia types.
Supports 72-hour Holter monitoring post-stroke for improved arrhythmia detection; extends RCT evidence on optimal monitoring duration.
Background/Introduction Holter-ECG monitoring is routinely performed after a stroke or transient ischemic attack, mainly to detect atrial fibrillation. The incidence and potential relevance of unexpected abnormalities on Holter ECG has not been systematically assessed. Purpose Quantification of ECG abnormalities Holter-ECG recording after a stroke stratified by sex and age and determination of the effect of prolonged Holter ECG monitoring. Methods We used data from the prospective multicenter MonDAFIS trial, which randomized patients with acute ischemic stroke or transient ischemic attack (TIA) without known AF to Holter-ECG recording up to 7 days or usual care. Such 24-hour and 72-hour recordings were analyzed. ECG abnormalities were classified locally and reviewed by a dedicated core lab. Results Supraventricular tachycardia was detected in 68/1655 (4.1%) patients and newly-diagnosed AF in 36/1655 2.2% patients during 24-hour ECG monitoring. Occasional premature ventricular complexes were highly prevalent (85.8%), ventricular couplets (28.0%) or bigeminy (14.0%) less so. Non-sustained ventricular tachycardia was detected in 1.7% of patients. Extended 72-hour-monitoring in 1,283 patients detected supraventricular tachycardia in 113/1283 patients (8.8%) and AF in 39/1283 (3.0%) with higher detection rates across all abnormalities. Supraventricular arrhythmias were more frequently identified in women, while ventricular arrhythmias were more common in men. Conclusion(s) Post-stroke ECG monitoring detects a broad spectrum of arrhythmias beyond AF in a substantial proportion of patients. Prolonged monitoring and higher age are associated with increased diagnostic yield, with distinct sex-specific differences in arrhythmia patterns.
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Thiessen et al. (2026) conducted an RCT in Acute ischemic stroke or transient ischemic attack without known atrial fibrillation (n=1,655). 72-hour Holter-ECG monitoring vs. 24-hour Holter-ECG monitoring was evaluated on Detection of supraventricular tachycardia and newly-diagnosed atrial fibrillation. Extended 72-hour Holter-ECG monitoring after stroke increased detection of supraventricular tachycardia to 8.8% vs 4.1% at 24 hours, and newly-diagnosed AF to 3.0% vs 2.2%.
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