Prolonged electrocardiographic monitorization with a wearable system after an embolic stroke of undetermined source

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Embolic cerebrovascular events that remain of unknown etiology after careful diagnostic evaluation are known as Embolic Strokes of Undetermined Source (ESUS). Subclinical atrial fibrillation (AF) is an important cause of ESUS. PURPOSE: Our aims were to analyze the global diagnostic yield of a prolonged cardiac monitoring wearable system (PCMw) after an ESUS to detect AF and factors associated with it, including the time frame from the ESUS event to PCMw initiation. METHODS: We retrospectively analyzed 200 ECG recordings (3-leads, 30 days duration) by means of a PCMw in patients with an ESUS to detect AF lasting longer than 30 seconds, between 2017-2021. RESULTS: AF was detected in 21 patients (10,5 %). Patients with AF had more left atrial enlargement (OR=4,22 [1.59-6.85]; p=0.01) and atrial arrythmias in the initial 24-h Holter during hospitalization (OR=5,73 [2.03-16,49]; p=0.001). The detection of AF was significatively higher if the PCMw was worn within the first 30 days after the ESUS compared to beyond 30 days (17% vs 10,3%; p=0,002). CONCLUSION: PCMw represents a feasible non-invasive device that could reliably detect subclinical AF episodes after an ESUS. Diagnostic yield was significatively higher when used within the first 30 days after the event, especially in selected patients.