ABSTRACT NUMBER: ESOC2026A1889 TIMELINESS OF ATRIAL FIBRILLATION/FLUTTER DETECTION AND ANTICOAGULATION INITIATION WITH EXTENDED AMBULATORY ECG AFTER STROKE/TIA

Abstract Background and aims Extended ambulatory ECG (aECG) monitoring improves detection of atrial fibrillation/flutter (AF/AFl) after ischemic stroke or transient ischemic attack (TIA), enabling targeted secondary prevention. However, delays between AF/AFl detection and anticoagulation initiation may expose patients to avoidable recurrent events. We aimed to quantify delays across the aECG pathway and assess their potential clinical impact. Methods We retrospectively analysed consecutive patients undergoing 14-day patch-based aECG monitoring after ischemic stroke or TIA between February 2024 and May 2025. Patients with known AF, incomplete records, age <18 years, or death during monitoring were excluded. In patients with newly detected AF/AFl, median time intervals from device fitting to report availability and from report availability to physician action (initiation or recommendation of anticoagulation) were calculated. AF/AFl detection timing was classified as early (days 1–7) or late (days 8–14). Recurrent stroke/TIA events occurring prior to anticoagulation were recorded. Results Among 1,641 monitored patients, AF/AFl was identified in 69 (4.2%; median age 79 years; 57% female). Median time from device fitting to report availability was 18 days (IQR 17–19), compared with 3 days (IQR 1–11) from report availability to physician action. AF/AFl was detected early in 41 patients (59%) and late in 28 (41%). Three patients experienced recurrent stroke/TIA before anticoagulation initiation. Conclusions The principal delay occurred prior to report availability, creating a prolonged high-risk period before secondary prevention. Real-time AF/AFl alerts and streamlined review pathways may shorten time to anticoagulation and reduce recurrent cerebrovascular events. Conflict of interest Dipraj Limbu: nothing to disclose; Radim Licenik: nothing to disclose; Amrit Gurung: nothing to disclose Figure 1 - belongs to Methods Figure 2 - belongs to Results