Late prolonged cardiac monitoring after cryptogenic ischemic stroke using a textile wearable Holter

Subclinical atrial fibrillation is a leading underlying cause of cryptogenic stroke. Early prolonged cardiac monitoring is recommended, yet timely access is often limited. We evaluated the performance and therapeutic implications of prolonged cardiac monitoring using the NUUBO ® wearable system in routine clinical practice, where initiating monitoring within the first 30 days after stroke was uncommon. This single-center ambispective study (2018–2024), included consecutive adults with cryptogenic ischemic stroke who underwent 15–28 days of cardiac monitoring with the NUUBO ® textile wearable system. The primary outcome was atrial fibrillation detection. Associations between atrial fibrillation and baseline or clinical characteristics were examined using multivariate logistic regression. Monitoring adherence and treatment changes were also recorded. 352 patients (99.4%) completed all the monitoring. Atrial fibrillation was detected in 38 patients (10.8%), leading to anticoagulation in 36 (94.7%). Advanced age (median 73 (interquartile range 69–80) vs. 66 (57–74) years; p < 0.001) and large-vessel occlusion at stroke onset (31.6% vs. 17.2%; p = 0.047) were independently associated with atrial fibrillation. Patients monitored within < 30 days, between 31 and 90 days, 91–365 days, or after 12 months of the index event had atrial fibrillation detection rates (9.5%-11.6%). NUUBO ® proved useful for detecting atrial fibrillation after cryptogenic ischemic stroke. Atrial fibrillation was detected even among patients monitored late (9.5–11.6%). These findings provide a useful starting point for further studies aimed at confirming whether significant atrial fibrillation detection rates can be achieved with delayed prolonged cardiac monitoring after cryptogenic ischemic stroke.