COMMENTARY—Technology Is Outstripping Proof

There is widespread belief among most stroke neurologists that when you have a stroke that looks embolic and you don't have a source, you need to monitor for longer than we have done traditionally. The nuances are really how to do that. This is a great approach; it's a lot easier than wearing a 30-day Holter monitor or having an implanted device, but we have to compare it with other approaches and see what the heart end points really are to know if it's the best approach. I think that everybody in the stroke community appreciates that the more you monitor, the more you are likely to find atrial fibrillation. How long you should monitor, by what technique, and whether monitoring should be continuous or intermittent are unanswered questions. The other question is how much atrial fibrillation is significant. Is a 30-second run significant, or does it need to be minutes at a time? These questions need to be answered before there's a wholesale buy-in for this kind of monitoring for every patient.

—Kyra Becker, MD,
Professor of Neurology and
Neurological Surgery,
Director of Vascular
Neurology Services,
Comprehensive Stroke
Center in Seattle,
University of Washington,
Seattle