title: Finding atrial fibrillation in stroke patients: Randomized evaluation of enhanced and prolonged Holter monitoring--Find-AF(RANDOMISED) --rationale and design.
abstract: BACKGROUND
  Detecting paroxysmal atrial fibrillation (AF) in patients with ischemic strokes presenting in sinus rhythm is challenging because episodes are often short, occur randomly, and are frequently asymptomatic. If AF is detected, recurrent thromboembolism can be prevented efficiently by oral anticoagulation. Numerous uncontrolled studies using various electrocardiogram (ECG) devices have established that prolonged ECG monitoring increases the yield of AF detection, but most established procedures are time-consuming and costly. The few randomized trials are mostly limited to cryptogenic strokes. The optimal method, duration, and patient selection remain unclear. Repeated prolonged continuous Holter ECG monitoring to detect paroxysmal AF within an unspecific stroke population may prove to be a widely applicable, effective secondary prevention strategy.
  
  
  METHODS
  Find-AFRANDOMISED is a randomized and controlled prospective multicenter trial. Four hundred patients 60 years or older with manifest (symptoms ≥24 hours or acute computed tomography/magnetic resonance imaging lesion) and acute (symptoms ≤7 days) ischemic strokes will be included at 4 certified stroke centers in Germany. Those with previously diagnosed AF/flutter, indications/contraindications for oral anticoagulation, or obvious causative blood vessel pathologies will be excluded. Patients will be randomized 1:1 to either enhanced and prolonged Holter ECG monitoring (10 days at baseline and after 3 and 6 months) or standard of care (≥24-hour continuous ECG monitoring, according to current stroke guidelines). All patients will be followed up for at least 12 months.
  
  
  RESULTS
  The primary end point is newly detected AF (≥30 seconds) after 6 months, confirmed by an independent adjudication committee. We plan to complete recruitment in autumn 2014. First results can be expected by spring 2016.
authors.affiliation: Clinic for Cardiology and Pneumology, University of Göttingen, Göttingen, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: Weber-Krüger
authors.affiliation: Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany; Clinical Trial Centre, University of Würzburg, Würzburg, Germany.
authors.forename: Götz
authors.initials: G
authors.lastname: Gelbrich
authors.affiliation: Helios Albert-Schweitzer-Kliniken Northeim, Germany.
authors.forename: Raoul
authors.initials: R
authors.lastname: Stahrenberg
authors.affiliation: Clinic for Neurology, University of Göttingen, Göttingen, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Liman
authors.affiliation: Department of Neurology, Nordwest-Krankenhaus Sanderbusch, Sande, Germany.
authors.forename: Pawel
authors.initials: P
authors.lastname: Kermer
authors.affiliation: Department of Neurology and Neurological Rehabilitation, Bezirkskliniken Günzburg, Germany.
authors.forename: Gerhard F
authors.initials: GF
authors.lastname: Hamann
authors.affiliation: Department of General Medicine II, University of Regensburg, Regensburg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Seegers
authors.affiliation: Clinic and Polyclinic for Neurology, University of Mainz, Mainz, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Gröschel
authors.affiliation: Clinic for Cardiology and Pneumology, University of Göttingen, Göttingen, Germany. Electronic address: wachter@med.uni-goettingen.de.
authors.forename: Rolf
authors.initials: R
authors.lastname: Wachter
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed