Prolonged Rhythm Monitoring in the Patient with Stroke and Transient Ischemic Attack

Abstract

Stroke patients undergo prolonged cardiac monitoring based on concern that those currently classified as having a cryptogenic cause and treated with antiplatelet therapy may actually have paroxysmal atrial fibrillation and merit anticoagulation for secondary stroke prevention. Technological advances have produced monitoring devices that can be applied to any patient, are capable of capturing electrocardiogram information accurately and continuously, and can relay critical data to the physician promptly and without the need for patient participation. Even if it is assumed that monitors can detect arrhythmias with perfect accuracy, it has yet to be demonstrated in clinical trials that more strokes can be prevented by anticoagulation guided by the findings of prolonged rhythm monitoring. As newer monitoring technology and safer anticoagulants continue to become available, clinical trials need to be conducted to determine the best clinical practice for stroke prevention in this rapidly evolving field.