Background and aims Rapid and sensitive detection of atrial fibrillation (AF) is of paramount importance for starting adequate antithrombotic preventive therapy early after stroke. Stroke Unit care includes continuous ECG monitoring (CEM) but the optimal exploitation of recorded ECG traces is controversial. Methods In this retrospective, unsponsored single-centre study, we compared the yield of routine CEM versus an automated continuous electrocardiogram monitoring (ACEM) based on remote software algorithm (SRA-clinic-Apoplex-technologies) to detect AF in patients admitted to our Stroke Unit. We also investigated whether ACEM shortens the time of AF detection compared to CEM. We identified consecutive patients with acute ischemic stroke who were in sinus rhythm on admission and no history of AF. Patients were identified during two distinct recruitment phases: between 1st June and 31st August 2017 for the CEM cohort, and between 1st June and 30th September 2018 for the ACEM cohort. Results Overall, 208 of the 407 patients (51.11%) in the CEM group and 114 of the 241 patients in the ACEM group (47.30%) fulfilled the eligibility criteria (Table 1). We found a lower rate of newly-detected AF in the CEM cohort compared to the ACEM cohort (10.1% vs. 15.8%%, p < 0.001). Moreover, median time to first detection of AF was longer in the CEM cohort compared to the ACEM cohort [46.50 hours (IQR 0-108.25) vs. 10 hours (IQR 0-23), p < 0.001](Table 2)(Figure 1). Conclusions This study supports that ACEM results in a higher rate of AF detection than CEM. ACEM accelerates AF detection and may support earlier initiation of anticoagulation.
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