Wearable ECG Monitoring After Embolic Stroke of Undetermined Source
A small study of a wearable ECG system detected intermittent atrial fibrillation in two participants and reported generally acceptable wearability.
Looking beyond a short recording
Atrial fibrillation can occur intermittently, so a brief ECG may miss an episode. The ACROSS-AF in ESUS study evaluated a wearable, Holter-type ECG system that can record for up to 14 days in people with embolic stroke of undetermined source (ESUS).
The study enrolled 31 people; 29 were included in the monitoring analysis. Average recording duration was about 12 days, while the average analyzable ECG duration was about 8 days. The difference matters: a device can be worn for many days without yielding continuous usable signal.
Detection and wearability findings
Among 27 participants in the acute-phase analysis, paroxysmal atrial fibrillation was identified in two (7.4%). The reported ECG acquisition rate averaged 64%, with substantial variation across participants. In the wearability questionnaire, 77.8% said the device did not interfere with daily activities, and 72.7% reported adapting to it within one to four days.
These observations suggest that extended monitoring can be feasible in this setting and can capture episodes that may not appear on a shorter recording. The study is too small to estimate detection performance reliably for all ESUS patients or to show that the device changes clinical outcomes.
What the numbers do—and do not—mean
This was a descriptive feasibility study, not a randomized comparison of monitoring strategies. The 7.4% figure is the observed detection rate in this cohort, not a general prevalence estimate. Larger studies should examine signal completeness, patient burden, clinical follow-up, and how detections affect treatment decisions.
Source and credit
Independent summary of “Utility and Wearability of the hitoe® Wearable ECG Monitoring System II for Detecting Covert Paroxysmal Atrial Fibrillation in Patients with Suspected ESUS Across Inpatient and Outpatient Settings: ACROSS-AF in ESUS,” Neurology International, published 13 July 2026. Original paper, DOI: 10.3390/neurolint18070134. Source article license: CC BY 4.0. No source figures or tables are reproduced here.
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