Atrial Fibrillation Trial to Evaluate Real-World Procedures for Unearthing Its Location after Stroke Events (After-Pulse)

Background: Enhancing detection of undiagnosed atrial fibrillation (AF) in hospitalized patients with a recent ischemic stroke is important because of the treatment implications; especially since presence of paroxysmal AF may not be picked up in a single 12-lead electrocardiogram (ECG) test. While several trials have shown improved detection of AF with prolonged ECG monitoring, this strategy is associated with relatively high cost, labor intensity, and patient inconvenience, thereby making it challenging to routinely implement in all hospitals. Fortunately, conventional 24-hour Holter monitoring and repeated 12-lead ECGs are readily available to detect paroxysmal AF in all hospitals, but is unclear which is the better strategy for evaluating undiagnosed AF. Objective: To conduct a randomized trial of serial 12-lead ECGs vs. 24-hour Holter monitoring in the detection of AF in ischemic stroke patients without known AF. Methods: We plan to enroll 800 participants from six hospitals in Taiwan. Patients will be eligible for enrollment if they are admitted due to acute ischemic stroke within 7 days, are ≥65 years of age, have no known atrial fibrillation by history or on baseline ECG at admission. We will randomly assign participants in a 1:1 ratio to undergo daily 12-lead ECG once daily for 5 days (intervention group) or 24-hour Holter monitoring (control group). Primary outcome is newly detected atrial fibrillation on a 12-lead ECG or atrial fibrillation lasting ≥30 seconds on Holter monitoring. Discussion: The results of the trial will help to decide which of these routinely available strategies is more effective for the detection of undiagnosed paroxysmal AF in elderly patients with a recent ischemic stroke. Trial Registration: ClinicalTrials.gov Identifier: NCT02578979

Project ID:PC10601-0860
External Project ID:MOST105-2628-B182-008-MY2