Internal and Emergency Medicine

, Volume 9, Issue 1, pp 65–67 | Cite as

96 hours ECG monitoring for patients with ischemic cryptogenic stroke or transient ischaemic attack

  • Giorgia Manina
  • Giancarlo Agnelli
  • Cecilia Becattini
  • Gianluca Zingarini
  • Maurizio Paciaroni


Atrial fibrillation (AF) is intermittent in 30% of patients with cardioembolic stroke and, therefore, might not be seen in a single standard ECG recording. The aim of this study was to evaluate if prolonged ECG monitoring (96 h) finds episodes of intermittent AF beyond the 24 h ECG monitoring in patients with cryptogenic stroke or transient ischemic attack (TIA). We prospectively evaluated consecutive patients affected by cryptogenic stroke or TIA who had sinus rhythm on a 12-lead ECG on admission, and during ECG monitoring performed in the acute phase (for at least 24 h). Patients had continuous 96 h Holter ECG monitoring within 30 days from stroke onset. 114 patients were included in the study (mean age 63.1 ± 15.1, 59 males). AF was found in 29 patients (24.3%). In 20 patients, AF was found in the first 24 h of recording, and in nine patients after 24 h. In addition, several other dysrhythmias such as supraventricular ectopic activity (33), ventricular tachycardia (10), sinus pause (4) and sinus-atrial block (1) were found. In patients with cryptogenic stroke or TIA, 96 h ECG monitoring detected a high rate of AF. One-third of AF was seen beyond 24 h of ECG monitoring.


Cryptogenic stroke ECG monitoring Atrial fibrillation 


Conflict of interest



  1. 1.
    Vingerhoets F, Bogousslavsky J, Regli F, Van Melle G (1993) Atrial fibrillation after acute stroke. Stroke 24:26–30PubMedCrossRefGoogle Scholar
  2. 2.
    Flaker GC, Belew K, Beckman K, Vidaillet H, Kron J, Safford R, Mickel M, AFFIRM Investigators (2005) Asymptomatic atrial fibrillation: demographic features and prognostic information from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Am Heart J 149(4):657–663PubMedCrossRefGoogle Scholar
  3. 3.
    Guercini F, Acciarresi M, Agnelli G, Paciaroni M (2008) Cryptogenic stroke: time to determine aetiology. J Thromb Haemost 6:549–554PubMedCrossRefGoogle Scholar
  4. 4.
    Marini C, De Santis F, Sacco S, Russo T, Olivieri L, Totaro R, Carolei A (2005) Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study. Stroke 36(6):1115–1119PubMedCrossRefGoogle Scholar
  5. 5.
    Glotzer TV, Daoud EG, Wyse DG, Singer DE, Ezekowitz MD, Hilker C, Miller C, Qi D, Ziegler PD (2009) The relationship between daily atrial tachyarrhythmia burden from implantable device diagnostics and stroke risk: the TRENDS study. Circ Arrhythm Electrophysiol. 2:474–480PubMedCrossRefGoogle Scholar
  6. 6.
    Binici Z, Intzilakis T, Nielsen OW, Kober L, Sajadieh A (2010) Excessive supraventricular ectopic activity and increased risk of atrial fibrillation and stroke. Circulation 121:1904–1911PubMedCrossRefGoogle Scholar
  7. 7.
    Liao J, Khalid Z, Scallan C, Morillo C, O’Donnell M (2007) Noninvasive cardiac monitoring for detecting paroxysmal atrial fibrillation or flutter after acute ischemic stroke: a systematic review. Stroke 38:2935–2940PubMedCrossRefGoogle Scholar
  8. 8.
    Jabaudon D, Sztajzel J, Sievert K, Landis T, Sztajzel R (2004) Usefulness of ambulatory 7-day ECG monitoring for the detection of atrial fibrillation and flutter after acute stroke and transient ischemic attack. Stroke 35:1647–1651PubMedCrossRefGoogle Scholar
  9. 9.
    Bansil S, Karim H (2004) Detection of atrial fibrillation in patients with acute stroke. J Stroke Cerebrovasc Dis. 13:12–15PubMedCrossRefGoogle Scholar
  10. 10.
    Tayal AH, Tian M, Kelly KM, Jones SC, Wright DG, Singh D, Jarouse J, Brillman J, Murali S, Gupta R (2008) Atrial fibrillation detected by mobile cardiac outpatient telemetry in cryptogenic TIA or stroke. Neurology 71:1696–1701PubMedCrossRefGoogle Scholar
  11. 11.
    Elijovich L, Josephson SA, Fung GL, Smith WS (2009) Intermittent atrial fibrillation may account for a large proportion of otherwise cryptogenic stroke: a study of 30-day cardiac event monitors. J Stroke Cerebrovasc Dis. 18:185–189PubMedCrossRefGoogle Scholar
  12. 12.
    Capucci A, Santini M, Padeletti L, Gulizia M, Botto G, Boriani G, Ricci R, Favale S, Zolezzi F, Di Belardino N, Molon G, Drago F, Villani GQ, Mazzini E, Vimercati M, Italian AT500 Registry Investigators (2005) Monitored atrial fibrillation duration predicts arterial embolic events in patients suffering from bradycardia and atrial fibrillation implanted with antitachycardia pacemakers. J Am Coll Cardiol 46:1913–1920PubMedCrossRefGoogle Scholar
  13. 13.
    Botto GL, Padeletti L, Santini M, Capucci A, Gulizia M, Zolezzi F, Favale S, Molon G, Ricci R, Biffi M, Russo G, Vimercati M, Corbucci G, Boriani G (2009) Presence and duration of atrial fibrillation detected by continuous monitoring: crucial implications for the risk of thromboembolic events. J Cardiovasc Electrophysiol 20:241–248PubMedCrossRefGoogle Scholar
  14. 14.
    Bhatt A, Majid A, Razak A, Kassab M, Hussain S, Safdar A (2011) Predictors of occult paroxysmal atrial fibrillation in cryptogenic strokes detected by long-term noninvasive cardiac monitoring. Stroke Res Treat 2011:172074Google Scholar

Copyright information

© SIMI 2012

Authors and Affiliations

  • Giorgia Manina
    • 1
    • 3
  • Giancarlo Agnelli
    • 1
  • Cecilia Becattini
    • 1
  • Gianluca Zingarini
    • 2
  • Maurizio Paciaroni
    • 1
  1. 1.Division of Internal and Cardiovascular Medicine, Stroke UnitUniversity of PerugiaPerugiaItaly
  2. 2.Division of CardiologySanta Maria della Misericordia HospitalPerugiaItaly
  3. 3.Division of Cardiovascular Medicine, Stroke Unit, Santa Maria della Misericordia HospitalUniversity of PerugiaPerugiaItaly

Personalised recommendations