Automatic cardiac event recorders reveal paroxysmal atrial fibrillation after unexplained strokes or transient ischemic attacks

Background: The etiology of stroke or transitory ischemic attack (TIA) remains frequently unknown. While paroxysmal atrial fibrillation (PAF) is often suspected, its presence remains difficult to establish. Therefore, we investigated the occurrence of PAF episodes in such a population using a long-term automatic cardiac event recorder. Methods: We prospectively investigated 60 consecutive subjects admitted in our university hospital for stroke (n = 44) or TIA (n = 16), adding long-term automatic cardiac event recorders, with a target duration of 4 days, to standard investigations, which included 12-lead ECGs and 24-hour Holter recordings. Results: In 28 patients no etiology was found for their stroke or TIA. However, one or more than one PAF episode was found in 4 of them (14.3%) using the long-term automatic event recorder. In the 32 remaining patients, 8 presented with PAF, and this was considered as the cause of their stroke. In both groups, AF was paroxysmal. The PAF episodes' duration went from 1 to 96 hours (mean +/- standard deviation, 18 hours and 30 minutes +/- 30 hours). Conclusions: Patients suffering PAF episodes after ischemic stroke or TIA were statistically less often recognized using the 24-hour Holter ECG recording alone than the R-Test Evolution alone.