Atrial fibrillation detection using a automated electrocardiographic monitoring in a transient ischaemic attack service

BACKGROUND: The vast majority of the transient ischaemic attacks (TIA) services in UK reported significant delays in the initiation of the routine cardiac monitoring that may result in a significant number of missed atrial fibrillation (AF) paroxysms and increased long-term risk of recurrent stroke. Automated continuous ECG monitoring (ACEM) system has shown promising results in terms of AF detection but it is unclear if ACEM improves AF detection in a rapid outpatient TIA service. OBJECTIVES: We assessed ACEM in patients with TIA with the aim to significantly reduce the delay to initiate the cardiac monitoring and to enhance the yield of AF detection in these patients. We also aimed to determine the impact of a more rapid initiation of ACEM on the 6-month risk of recurrent stroke/TIA. METHODS: This is an observational, prospective before (phase 1: 1 July to 31 December 2018) versus after (phase 2: 1 January to 30 June 2019) study of the effect of ACEM, compared with routine initiation of 24h-Holter ECG, in patients with TIA assessed in our service. RESULTS: The phase 1 (n=136) and phase 2 (n=105) cohorts did not differ with regards to age, risk factors, duration of cardiac monitoring. The rate of newly detected AF was significantly higher in phase 2 compared with phase 1 (9.52% vs 2.21%, p<0.001). The 6-month risk of recurrent stroke/TIA was significantly lower in phase 2 compared with phase 1 (7.4% vs 1%, p=0.018). CONCLUSIONS: Early initiation of ACEM improves AF detection after TIA in a rapid TIA service and is associated with a reduced risk of recurrent TIA/stroke.