{
  "abstract": "Introduction Detection of atrial fibrillation/flutter (AF/AFl) following ischaemic stroke or transient ischaemic attack (TIA) is central to effective secondary prevention. Short-duration Holter monitoring (24–72 hours) is widely used but may fail to identify paroxysmal AF/AFl. Extended patch-based ECG monitoring has been increasingly adopted; however, the timing of AF/AFl detection in routine clinical practice remains incompletely characterised. We evaluated the temporal pattern of AF/AFl detection using 14-day ambulatory ECG monitoring to estimate the incremental diagnostic yield beyond the first week of monitoring.Methods We conducted a retrospective analysis of consecutive patients undergoing 14-day patch-based ambulatory ECG monitoring following ischaemic stroke or TIA between February 2024 and May 2025 at a tertiary NHS centre. Patients with known AF/AFl, incomplete records, age <18 years, or death during monitoring were excluded. The timing of first AF/AFl detection was categorised as early (days 1–7) or late (days 8–14). The proportion of AF/AFl detected after day 7 was used as a surrogate for cases likely to be missed by conventional short-duration monitoring strategies.Results A total of 1,641 patients underwent extended ECG monitoring. Newly detected AF/AFl was identified in 69 patients (4.2%; median age 79 years; 57% female). AF/AFl was detected during days 1–7 in 41 patients (59%), while 28 patients (41%) had first detection during days 8–14. Thus, over two-fifths of AF/AFl diagnoses occurred beyond the first week of monitoring and would probably not have been identified using standard Holter durations of ≤7 days.Conclusions In a real-world post-stroke/TIA population, a substantial proportion of AF/AFl is detected only after the first week of monitoring. These findings highlight the limitations of short-duration Holter strategies and support routine use of extended-duration ambulatory ECG monitoring to improve detection of occult AF/AFl and optimise secondary stroke prevention.",
  "authors": [
    {
      "affiliations": [
        "Peterborough City Hospital/North West Anglia NHS Foundation Trust, Peterborough, United Kingdom"
      ],
      "name": "Dipraj Limbu"
    },
    {
      "affiliations": [
        "Peterborough City Hospital/North West Anglia NHS Foundation Trust, Peterborough, United Kingdom"
      ],
      "name": "Radim Licenik"
    },
    {
      "affiliations": [
        "Peterborough City Hospital/North West Anglia NHS Foundation Trust, Peterborough, United Kingdom"
      ],
      "name": "Amrit Gurung"
    }
  ],
  "title": "429 Incremental diagnostic yield of 14-day patch ECG monitoring beyond 7 days after stroke or TIA",
  "uid": "b96cfd47-105a-5fb6-a016-412b5411de6e"
}