Ischemic Stroke in Atrial Fibrillation: Detection by ECG at Admission versus Prolonged Monitoring

Abstract

Introduction : Atrial fibrillation (AF) is a major risk factor for ischemic stroke (IS). Its diagnosis can be challenging, particularly for paroxysmal forms. This study aims to compare the clinical and prognostic characteristics of IS due to AF detected by an admission ECG versus those detected by prolonged ECG monitoring (Holter ECG). Methods : A retrospective observational study was conducted at CHU Ibn Rochd in Casablanca between January 2023 and May 2024. We included cardioembolic IS with newly diagnosed AF, divided into two groups: AF detected by ECG at admission (Group A) and AF detected by 24 h - 72 h Holter ECG (Group B). Demographic, clinical, and radiological data were collected and analyzed. Results : Among 66 patients with cardioembolic IS, 50 (75.8%) had AF. The mean age was 68.5 years. AF was detected by standard ECG in 76% of cases and by Holter ECG in 24%. Paroxysmal AF accounted for 84% of cases. The median NIHSS score at admission was 7.5. In 69.7% of cases, the stroke involved the carotid territory. There was no significant difference in stroke severity or functional outcome between Groups A and B. The stroke recurrence rate was 2.9%. Conclusion : The high prevalence of newly diagnosed AF (75.8%) highlights the importance of systematic screening. The absence of a significant difference between Groups A and B in terms of severity and functional outcomes is intriguing and warrants further long-term follow-up studies.