Detection of cardio embolic stroke attributable to subclinical atrial fibrillation in patients of cryptogenic stroke presenting to a tertiary referral centre in Indian context

Background: Large number of stroke cases are clearly not attributable to athero-thrombosis .Such cases are labeled as cryptogenic stroke.Recently there is growing recognition of the importance of subclinical atrial fibrillation as a cause of cryptogenic stroke & there have been efforts to pick up these arrhythmias through various devices. Aims: To detect subclinical atrial fibrillation in Indian adult acute ischemic stroke patients after ruling out possible identifiable causes. Materials and Methods: 60 consecutive patients of ischemic stroke were enrolled in the study. MR angiography brain, 2D Echo & stroke profile was done in all cases. Patients with cryptogenic stroke were subjected to 24 hour holter monitoring.Statistical Analysis: The data was entered in Microsoft excel format and analyzed using the Vassar stats software. Results: Atrial fibrillation was detected in 13 % patients. Holter monitoring was useful in identifying AF cases missed by ECG. Conclusions: 24 hour holter monitoring in the immediate post stroke period can significantly improve atrial fibrillation detection rate but longer monitoring time may increase the yield of detection and change management decisions in these patients.