Experience and insights from a prolonged electrocardiographic monitorization with a wearable system after an embolic stroke of unknown source.

Abstract

Embolic cerebrovascular events that remain of unknown etiology after a thorough diagnostic evaluation, are known as Embolic Strokes of Undetermined Source (ESUS). Subclinical atrial fibrillation (AF) represents a significant underlying cause of ESUS. Our aims were to examine the overall 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. Additionally, to evaluate the frequency of unexpected arrhythmic events (UAE) and their prognostic implications. We retrospectively analyzed 200 ECG recordings (3-leads, 30days duration) by means of a PCMw in patients with an ESUS to detect AF lasting longer than 30s, between 2017 and 2021. UAE were defined as arrhythmia events that were not correlated to the main reason of prolonged cardiac monitoring. AF was detected in 21 patients (10.5%). Patients with AF had more left atrial enlargement (OR=4.22 [1.59-6.85]; p=.01) and atrial arrythmias in the initial 24-h Holter during hospitalization (OR=5.73 [2.03-16.49]; p=.001). The detection of AF was significatively higher if the PCMw was worn within the first 30days after the ESUS compared to beyond 30days (17% vs. 10.3%; p=.002). Fifty three patients (26.5%) had UAE during PCMw. In six of them these findings led to targeted treatment. 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 30days after the event, especially in selected patients. UAE were common, but did not impact prognosis.