Background: Atrial fibrillation (AF) frequently escapes routine stroke workup due to its unpredictable and often asymptomatic nature, leaving a significant portion of patients at high risk of recurrent stroke unrecognized. Recent trials emphasized continuous ECG monitoring in the detection of occult AF. We screened AF in patients meeting the embolic stroke of unknown source (ESUS) criteria using an external miniaturized recorder attached to an electrode plaster. Methods: Patients aged ≥50 with recent ESUS were prospectively screened and assigned to wear a 1-lead ECG-device capable to record continuous ECG for up to 4 weeks. Electrodes were replaced every 3-4 days. Primary outcome was proportion of patients completing at least 80% of monitoring. Secondary outcome measures included incidence of AF and number of patients with oral anticoagulation therapy initiated after AF detection. Results: Fifty-seven patients were monitored (mean age 64.5±8.2 years, median delay from stroke to the start of monitoring 8 days, IQR 4-44). Of these, 51 patients (89.5%) completed at least 80% of the desired monitoring period. We detected AF ≥30 seconds in 7 patients (12.3%), all of whom initiated anticoagulation therapy. AF was revealed in 6 patients (85.7%) within the first week of monitoring. Compared to patients without AF, patients with AF were older (70.6±5.1 vs 63.6±8.3 years, P<0.011) and more obese (body mass index 30.0±3.4 vs 26.6±4.6, P<0.039.) Conclusions: Prolonged ECG monitoring with an external device using plaster electrodes is feasible in ESUS patients, since nine out of ten patients used the device appropriately and AF was detected in one out of eight patients.
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