24 HOUR HOLTER MONITORING IN DETECTING ATRIAL FIBRILLATION IN PATIENTS WITH ISCHEMIC STROKE

Abstract

Background: Atrial fibrillation (AF) is a leading cause of ischemic stroke, yet paroxysmal AF often remains undetected during routine evaluation. Holter monitoring provides a noninvasive method to identify occult AF and guide secondary prevention strategies.

Objective: To assess the ability of 24-hour Holter monitoring to identify atrial fibrillation among stroke patients with an ischemic stroke.

Methods: This cohort study was conducted in the Department of Neurology, Pak Emirates Military Hospital, Rawalpindi, over six months (March–August 2025). 262 consecutive adult patients with confirmed ischemic stroke were enrolled. Patients with prior AF or hemorrhagic stroke were excluded. All participants underwent standardized clinical evaluation, stroke classification, severity and 24-hour Holter monitoring. AF detection rates were analyzed across age groups and TOAST subtypes using chi-square and logistic regression, with significance set at p<0.05.

Results: Of 278 patients screened, 262 were included in the final analysis. The mean age of the cohort was 62.7 ± 10.5 years, and 61.8% were male. AF was newly detected in 53 patients, yielding an overall detection rate of 20.2%. The yield was highest in patients with cardioembolic (38.2%) and cryptogenic (24.0%) strokes. Patients with AF were significantly older and more likely to have a cardioembolic stroke etiology. The timing of Holter monitoring was not associated with the likelihood of AF detection.

Conclusion: A single 24-hour Holter monitor detected AF in one-fifth of patients with acute ischemic stroke, with the highest yield in older patients and those with cardioembolic or cryptogenic etiologies. These findings support the systematic use of this investigation to guide optimal anticoagulation therapy for secondary stroke prevention.