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Randomised controlled trial
Prolonged cardiac monitoring after cryptogenic stroke superior to 24 h ECG in detection of occult paroxysmal atrial fibrillation
  1. Daniel J Miller
  1. Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA
  1. Correspondence to : Dr Daniel J Miller, Department of Neurology, Henry Ford Hospital, 2799 West Gerand Blvd. CFP Rm 455, Detroit, MI 48202, USA; dmille12{at}

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Stroke remains a prevalent and devastating condition for many people across the world, it is a leading cause of disability and is associated with significant monetary and social losses, yet is considered to be a largely preventable disease. One-third of all strokes are considered cryptogenic after initial diagnostic evaluations. Cryptogenic stroke has been identified, only recently, as an important area of additional investigation. Part of the EMBRACE trial, Gladstone and colleagues’ study adds to mounting evidence that prolonged cardiac monitoring is needed to identify paroxysmal atrial fibrillation (PAF) in patients with cryptogenic stroke.


In this open-label, multicenter trial in Canada, 572 patients over the age of 55 with a recent cryptogenic stroke or transient ischaemic attack (TIA) were randomised to conventional 24 h ECG monitoring (Holter monitor) versus 30-day non-invasive, ambulatory ECG …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.