Detection of paroxysmal atrial fibrillation by prolonged electrocardiographic recording after ischaemic stroke in patients aged < 60 years: A study with 21-day recording using the SpiderFlash® monitor

Background. Many studies have suggested that longer duration of cardiac monitoring is suitable for the detection of occult paroxysmal atrial fibrillation (AF) after stroke; however, most studies involved patients aged > 65 years a population with a high stroke rate. Aims. To assess the incidence of paroxysmal AF in unselected young patients presenting with stroke. Methods. We included consecutive patients aged <60 years with a stroke diagnosis on magnetic resonance imaging. Aetiological screening included clinical history and examination, and biological and cardiac tests. Patients were included if they had no history of AF and if a 24-hour electrocardiogram recording detected no AF or atrial flutter. Patients wore the SpiderFlash monitor for 21 days after discharge from hospital. The primary outcome was detection of paroxysmal AF episodes lasting > 30 seconds during monitoring. The secondary outcome was detection of paroxysmal AF episodes lasting < 30 seconds and any arrhythmia during monitoring. Results. Among the 56 patients included (mean age 48 9 years), 39 had cryptogenic stroke (CS) and 17 had stroke of known cause (SKC). Cardiac monitoring was achieved in 54 patients (37 CS, 17 SKC); one CS patient had a paroxysmal AF episode lasting > 30 seconds and one CS patient had a paroxysmal AF episode lasting <30 seconds (versus no patients in the SKC group). Two CS patients and one SKC patient presented numerous premature atrial complexes. Non-sustained ventricular tachycardia was detected in one CS patient. Conclusion. This prospective observational study showed a low rate of paroxysmal AF among young patients presenting with stroke, on the basis of 21-day cardiac monitoring. This result highlights the need to identify patients who would benefit from such long monitoring. (c) 2015 Elsevier Masson SAS. All rights reserved.