Please note: In 2003, the CTF updated its Grades of Recommendations to include an "I Recommendation" for situations where insufficient evidence exists to allow a recommendation to be made. (Formerly, these situations were captured under a "C Recommendation".) This change is not retroactive, and all "C Recommendations" made prior to 2003 have not been reevaluated in light of the new "I" recommendation grade. For a discussion of these recommendation grades, please link to the 2003 article in the Canadian Medical Association Journal here.
| MANEUVER | EFFECTIVENESS | LEVEL OF EVIDENCE <REF> | RECOMMENDATION |
| Ambulatory ECG | The maneuver is safe but little is know about its sensitivity and specificity | Descriptive studies <36-39> (III) | |
| All patients presenting with stroke or transient ischemic attack | Detection of atrial fibrillation over initial ECG is 2.3% - 5.4% | Cohort and case-control studies <46-52> (II-2) | There is insufficient evidence to recommend for or against ambulatory ECG screening for patients presenting with stroke or transient ischemic attack (C) |
| Anticoagulation if atrial fibrillation detected after stroke | |||
| Patients with paroxysmal atrial fibrillation | Unknown | 25% of patients in large randomized controlled trial <19> (I) (no subgroup data provided) | There is fair evidence to generalize from chronic atrial fibrillation data and expert opinion to recommend therapy with warfarin (B)* |
*While direct evidence is lacking, anticoagulation should be strongly considered.