Abstract 16852: Pathological ECG Findings in 24-h-Holter-ECGs in Patients With Ischemic Stroke

Abstract

Introduction: ECG-monitoring covering several days is recommended by current guidelines to detect atrial fibrillation (AF) and other arrhythmias in stroke patients. In practice, the extent of rhythm monitoring varies. Here, we use data from the 24-hour screening-Holter-ECGs of the ongoing randomized multicenter trial Find-AF 2 to assess the rate of AF and other arrhythmias. Methods and Results: Find-AF 2 (NCT04371055) is a randomized and controlled open-label parallel multicenter trial with central AF adjudication (intervention arm) and blinded endpoint assessment. Patients ≥60 years with recent (≤30 days) ischemic strokes according to the AHA/ASA definition of any etiology are screened for eligibility. All eligible patients receive a 24-hour Holter-ECG prior to randomization. Holter ECG data are analyzed by the core laboratory using dedicated analysis software and following a predefined standard operation procedure. In this analysis, we included all 24-hour Holter-ECGs up to June 1, 2023. We analyzed 3742 24-hour-Holter-ECGs from 51 different centers and found new arrhythmias in 120 patients (3.2%). AF was detected in 61 patients (1.6%) with a median duration of the longest episode of 730 minutes [interquartile range (IQR) 220;1180] (see Figure 1). This led to the initiation of anticoagulation in all 61 patients (100%). In 47 patients (1.3%), pauses >2.5 s (mean 3.1s±0.5s; longest pause 4.8s) or relevant bradycardias <40 bpm were diagnosed. This resulted in the implantation of pacemakers in six patients. Finally, we found regular supraventricular tachycardias in 25 patients (0.7%; median duration 7.0 min [IQR 1.0;21.3]) - 24 of them had focal atrial tachycardias and one an AVNRT. Conclusion: Overall, 3.2% of ischemic stroke patients had pathological ECG findings, leading to a therapeutic change in 56%, most commonly anticoagulation for AF detection The number needed to screen for a change in medical management was 56.