According to data presented at the European Society of Cardiology Congress 2025, non-invasive extended heart rhythm monitoring may be effective in the diagnosis of clinically significant arrhythmias after stroke or transient ischemic attack (TIA).

Data from Barts Health NHS Trust and iRhythm Technologies included 1,044 consecutive patients across three acute stroke units between September 2022 and June 2024. Each patient underwent 14-day continuous ambulatory electrocardiographic (ECG) patch monitoring. This technique was originally intended for atrial fibrillation (AF) detection. Apart from AF, the analysis evaluated other clinically significant arrhythmias and their impact on management.

Of the total cohort, 49 patients had AF alone, 21 had AF with additional arrhythmias, and 170 had non-AF arrhythmias. Overall, 191 patients experienced clinically significant arrhythmias, with 83 (8%) requiring management changes, including pacemaker or implantable cardioverter-defibrillator placement (30%), implantable loop recorders (17%), or medication adjustments (53%).

The timing of detection remained clinically relevant. While 36% of events were identified within 24 hours, 46% occurred beyond 72 hours, and approximately 20% were detected only after 7 days of monitoring. Most arrhythmias were asymptomatic and would likely have remained undetected without systematic monitoring.

The diagnostic yield for clinically actionable non-AF arrhythmias (8%) was comparable to AF detection rates (6.7%) requiring anticoagulation in this population.

In conclusion, extended non-invasive monitoring provides a clinically useful strategy for detecting both AF and other significant arrhythmias after stroke. It supports timely intervention and may improve secondary prevention outcomes.