Background and Aims
Atrial fibrillation (AF) is a known risk factor for embolic stroke. Improved detection of AF reduces the risk of future strokes. Studies have shown that AF detection rates are highest close to the event, underlining the need for prompt diagnosis. Newer Adhesive Ambulatory ECG patch devices (AAECG) may offer alternatives to traditional cardiac telemetry.  This pragmatic study aimed to compare AAECG (Zio XT device) against traditional 24 hr ambulatory monitoring.

Method
Patients with minor stroke or TIA were recruited from the TIA Clinic at Croydon University Hospital. Patients had the AAECG applied in clinic and a 24 hour Holter ordered. Patients were subsequently followed up in clinic to review results. 

Results
30 patients were recruited. AF was detected in 1 patient using the AAECG  and none on the Holter. Patients waited a median of 59 days for the Holter (range 14-102days). Investigations were completed for 29 patients from the AAECG compared to 18 from Holter. All AAECG reports were available in clinic compared to 6 from the Holter. 

Cost of the investigation plus follow up was £367 and £440 for a Holter and an AAECG respectively. 



Conclusion
Although the Zio system is more expensive in operational costs, it provided a more comprehensive follow up, and allowed timely investigation and management. Nearly half the patients attending the follow up clinic did not have Holter results because of administrative issues. The use of AAECG will allow services to offer “one-stop” TIA clinics leading to improved patient care and experience.

IMPROVING DETECTION OF ATRIAL FIBRILLATION AFTER TRANSIENT ISCHAEMIC ATTACK AND STROKE