ECG monitoring of post-stroke occurring arrhythmias: an observational study using 7-day Holter ECG

Post-stroke arrhythmias represent a risk factor for complications and worse prognosis after cerebrovascular events. The aims of the study were to detect the rate of atrial fibrillation (AF) and other cardiac arrhythmias after acute ischemic stroke, by using a 7-day Holter ECG which has proved to be superior to the standard 24-h recording, and to evaluate the possible association between brain lesions and arrhythmias. One hundred and twenty patients with cryptogenic ischemic stroke underwent clinical and neuroimaging assessment and were monitored with a 7-day Holter ECG. Analysis of the rhythm recorded over 7 days was compared to analysis limited at the first 24 h of monitoring. 7-day Holter ECG detected AF in 4% of patients, supraventricular extrasystole (SVEB) in 94%, ventricular extrasystole (VEB) in 88%, short supraventricular runs (SVRs) in 54%, supraventricular tachycardia in 20%, and bradycardia in 6%. Compared to the first 24 h of monitoring, 7-Holter ECG showed a significant higher detection for all arrhythmias (AF p=0.02; bradycardia p=0.03; tachycardia p=0.0001; SVEB p=0.0002; VEB p=0.0001; SVRs p=0.0001). Patients with SVRs and bradycardia were older (p=0.0001; p=0.035) and had higher CHA(2)DS(2)VASc scores (p=0.004; p=0.026) respectively, in the comparison with patients without these two arrhythmias. An association was found between SVEB and parietal (p=0.013) and temporal (p=0.013) lobe lesions, whereas VEB correlated with insular involvement (p=0.002). 7-day Holter ECG monitoring proved to be superior as compared to 24-h recording for the detection of all arrhythmias, some of which (SVEB and VEB) were associated with specific brain areas involvement. Therefore, 7-day Holter ECG should be required as an effective first-line approach to improve both diagnosis and therapeutic management after stroke.

Automated summary

Post-stroke arrhythmias, including atrial fibrillation (AF) and other cardiac arrhythmias, can lead to complications and worsen prognosis after cerebrovascular events. This study used a 7-day Holter ECG to detect the occurrence of AF and other arrhythmias after acute ischemic stroke, and found that the 7-day monitoring was superior to the standard 24-hour recording in detecting arrhythmias. Some arrhythmias were also found to be associated with specific brain areas involvement. Thus, the 7-day Holter ECG should be required as a first-line approach to improve diagnosis and therapeutic management after stroke.