Extended ECG monitoring detected atrial fibrillation in 11.4% of ischaemic stroke patients and 8.4% of TIA patients, with no significant difference between the groups (p=0.156).
RCT (n=920)
1:1
Yes
Does extended ECG monitoring yield different rates of atrial fibrillation detection in patients with TIA compared to those with ischaemic stroke?
Extended ECG monitoring yields similar rates of atrial fibrillation detection in patients with TIA compared to those with ischaemic stroke, supporting equal screening recommendations for both groups.
Absolute Event Rate: 11.4% vs 8.4%
p-value: p=0.156
Abstract Background and aims Atrial fibrillation (AF) is a major risk factor of ischaemic stroke (IS). Up to a third of IS and transient ischaemic attacks (TIAs) are cryptogenic. Most guidelines recommend AF screening for IS patients in general and for cryptogenic IS in particular. Screening for AF in TIA remains unaddressed in some guidelines, and limited data exist on the prevalence of AF in this population. In this study, we aimed to assess differences in AF detection yield between TIA and IS patients using extended ECG monitoring. Methods An interim analysis was conducted within the multicentre randomised controlled trial AF SPICE. Patients aged ≥70 years with IS or TIA on admission and no previous AF were randomised 1:1 from 2022 to 2024 to extended screening (intervention), with continuous one-lead ECG patch monitoring for 14 + 14 days, or standard screening (control). AF prevalence in the intervention group was compared between IS and TIA patients. Logistic regression, crude and adjusted for confounders, was applied. Results In total, 920 patients were randomised to the intervention arm. The median age was 78.0 years, 53.0% of the patients were women, and 36.1% had a TIA diagnosis. In an intention-to-screen analysis, there was no statistically significant difference in AF detection between IS and TIA (11.4% vs 8.4%; p = 0.156). Adjustment for age, sex and cardiovascular risk factors did not change the result. Conclusions AF detection yield did not differ between IS and TIA using extended ECG monitoring. These finding support AF screening for both IS and TIA patients equally. Conflict of interest Lassi Koski: Nothing to declare. Kajsa Strååt: Nothing to declare. Elisabeth Rooth: Nothing to declare. Per Wester: PW reports consulting fees, fees as a Clinical Events Committee member and unrestricted grants from Abbott, and is a member of the steering committee of Riksstroke, the Swedish Stroke Register. Johan Engdahl: JE has received consultant or lecture fees from Roche Diagnostics, Pfizer, Bristol Myers Squibb, Boehringer Ingelheim, Piotrode and Philips, as well as research grants from the Swedish Research Council, the Swedish Heart & Lung Foundation, the Swedish Innovation Agency and the Stockholm Region. Louise Ziegler: Nothing to declare.
Koski et al. (2026) conducted an RCT in Ischaemic stroke or transient ischaemic attack (n=920). Extended screening with continuous one-lead ECG patch monitoring vs. Standard screening was evaluated on Atrial fibrillation detection yield (comparing IS vs TIA within the intervention arm) (p=0.156). Extended ECG monitoring detected atrial fibrillation in 11.4% of ischaemic stroke patients and 8.4% of TIA patients, with no significant difference between the groups (p=0.156).