Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 2;25(1):191-199.
doi: 10.18295/2075-0528.2824.

Utility of Routine 24-Hour Electrocardiographic Holter Monitoring for Detecting Atrial Fibrillation in Patients Admitted with Acute Stroke Syndromes

Salim Al-Busaidi  1   2 , Hatim Al-Lawati  2 , Nasiba Al-Maqrashi  1 , Arunodaya R Gujjar  2
Affiliations

Utility of Routine 24-Hour Electrocardiographic Holter Monitoring for Detecting Atrial Fibrillation in Patients Admitted with Acute Stroke Syndromes

Salim Al-Busaidi et al. Sultan Qaboos Univ Med J. .

Abstract

Objectives: This study aimed to assess the operating characteristics of standard 12-lead electrocardiogram (ECG) and 24-hour Holter studies in detecting atrial tachyarrhythmia in patients with acute stroke syndromes. The study's objective was to determine the potential factors that increased the likelihood of detecting atrial fibrillation (AF) and its impact on management.

Methods: This retrospective cohort study included adults (aged ≥18 years) admitted at Sultan Qaboos University Hospital from January 2010 to December 2019, with ischaemic stroke or transient ischaemic attack and had undergone a 24-hour Holter study. The hospital stroke registry was used to screen patients.

Results: A total of 1,258 patients were screened and only 460 patients, who had undergone 521 Holter studies, met the inclusion criteria. Among them, AF was detected with baseline ECG in 20 patients (4.4%), while new AF was detected in only eight patients (1.7%). Significant predictors for increased AF detection by Holter included advanced age, peripheral vascular disease (PVD), left ventricular diastolic dysfunction and chronic kidney disease Stage III, with PVD highlighted as an independent predictor (odds ratio = 17.133, 95% confidence interval = 2.139-137.201, P = 0.007). The degree of agreement between the baseline ECG and Holter ECG was substantial (K = 0.649, P < 0.001). A total of 130 Holter needs to be performed to detect one case of treatable AF.

Conclusions: This study showed that a routine ECG Holter study in acute stroke has a low clinical yield in detecting AF, which is in substantial agreement with baseline ECG. Therefore, further investigation of paroxysmal AF in acute stroke should be reserved for high-risk patients.

Keywords: Ambulatory; Atrial Fibrillation; Cerebrovascular Disease; Cryptogenic; Electrocardiography; Ischaemic Stroke; Stroke; Transient Ischaemic Attack.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2020 update: A report from the American Heart Association. Circulation 2020; 141:e139–e596. https://doi.org/10.1161/CIR.0000000000000757. 10.1161/CIR.0000000000000757 - DOI - DOI - PubMed
    1. Collaborators GBDS . Global, regional, and national burden of stroke and its risk factors, 1990–2019: A systematic analysis for the global burden of disease study 2019. Lancet Neurol 2021; 20:795–820. https://doi.org/10.1016/S1474-4422(21)00252-0. 10.1016/S1474-4422(21)00252-0 - DOI - DOI - PMC - PubMed
    1. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: The Framingham study. Stroke 1991; 22:983–8. https://doi.org/10.1161/01.str.22.8.983. 10.1161/01.str.22.8.983 - DOI - DOI - PubMed
    1. Marini C, De Santis F, Sacco S, Russo T, Olivieri L, Totaro R, et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: Results from a population-based study. Stroke 2005; 36:1115–9. https://doi.org/10.1161/01.str.0000166053.83476.4a. 10.1161/01.str.0000166053.83476.4a - DOI - DOI - PubMed
    1. Winter Y, Wolfram C, Schaeg M, Reese J-P, Oertel WH, Dodel R, et al. Evaluation of costs and outcome in cardioembolic stroke or TIA. J Neurol 2009; 256:954–63. https://doi.org/10.1007/s00415-009-5053-2. 10.1007/s00415-009-5053-2 - DOI - DOI - PubMed

LinkOut - more resources