ABSTRACT NUMBER: ESOC2026A1704 BRAIN–HEART INTERACTION AFTER ISCHEMIC STROKE: REAL-WORLD EVIDENCE FROM EXTENDED HOLTER-DETECTED ARRHYTHMIAS

Abstract Background Ischemic stroke is increasingly recognized as a systemic disorder capable of inducing cardiac rhythm disturbances through disruption of central autonomic control. While post-stroke monitoring has traditionally focused on atrial fibrillation, stroke-related brain–heart interaction may generate a broader spectrum of clinically silent arrhythmias that remain under-detected with routine electrocardiographic strategies. Objective To characterize the spectrum and timing of Holter-detected cardiac arrhythmias after acute ischemic stroke and evaluate these rhythm disturbances as manifestations of post-stroke brain–heart interaction beyond atrial fibrillation. Methods Patients selected with imaging-confirmed acute ischemic stroke underwent early post-stroke ambulatory electrocardiographic monitoring using a patch-based Holter system. Arrhythmias assessed included atrial fibrillation, supraventricular ectopy, short supraventricular runs, ventricular ectopy, bradyarrhythmias, and tachyarrhythmias. The temporal distribution of arrhythmia detection across monitoring days was analyzed descriptively. Results The cohort comprised 185 men and 94 women (Total, N = 279), with a mean age of 58.6 ± 13.5 years. New-onset atrial fibrillation was detected in 15 patients (5.4%), most commonly on the first day of monitoring, with additional cases identified on subsequent days, demonstrating the incremental diagnostic yield of extended monitoring. Non–atrial fibrillation arrhythmias were highly prevalent, including supraventricular and ventricular ectopic activity, short supraventricular runs, and rate disturbances. Multiple rhythm abnormalities coexisted, and most were asymptomatic, supporting a neurogenic mechanism related to post-stroke autonomic dysregulation rather than primary cardiac disease. Conclusions Extended Holter monitoring demonstrates that ischemic stroke is commonly accompanied by diverse cardiac arrhythmias, supporting a clinically meaningful brain–heart interaction and the need for comprehensive post-stroke rhythm assessment strategies. Conflict of interest NA