CONGRESS ABSTRACT

Background Atrial fibrillation (AF) related strokes account for 20 % of all ischemic stroke and 10 % of cryptogenetic stroke, furthermore AF has been found also in lacunar and atherothrombotic stroke. AF detection is important for secondary prevention. Many studies demonstrated that longer ECG monitoring leads to a higher detection of paroxysmal AF, and it’s recommended in selected patients. Holter ECG is still used in order to detect AF, but there are still some open questions as limited diagnostic yield. The aim of the present study is to investigate the usefulness of Holter ECG in patients with neuroimaging suggesting a cardioembolic source of the stroke.   Methods We considered 492 consecutive patients, hospitalized in the Neurology Unit with ischemic stroke or transient ischemic attack (TIA) from February 2022 to September 2023, who have been investigated with 24 h or 72 h Holter ECG. We evaluated AF registration, < 30 sec atrial tachycardia (TA) and cerebral lesions. Results 492 stroke patients have been investigated with Holter ECG, mean age was 74,3± 12,41 years, 58% were males and 42% females, the median CHA2DS2VAS was 4,98±3,06. 82% of these patients had hypertension, 20% diabetes, 29% dyslipidemia, 60% a previous stroke, 14% peripheral vascular disease, 14,9% coronary artery disease, 3,2% heart failure, 11% a history of cancer. The average left ventricular ejection fraction (LVEF) was 56,9 %.AF was detected in 4,5%, atrial tachycardia (AT) lasting less than 30 sec in 11,6% patients. We found supraventricular ectopic beats (SVEB) in 91%, repetitive in 18%. We analyzed neuroimaging of acute stroke in 50 patients in order to investigate for embolic pattern (defined as cortical lesions or lesions in multiple region). We didn’t find any significant relationship between AF detection and imaging embolic pattern.   Conclusions We found a low diagnostic usefulness of AF detection with 24 – 72 h Holter ECG, but our sample was underpowered. We hope that our dataset, when complete, could give more information about the role of Holter ECG usefulness in patients with neuroimage suggestive for cardioembolic stroke