Pattern of Arrhythmia among Ischemic Stroke Patients on 24-hour Ambulatory Electrocardiography (Holter ECG) in South-South Nigeria

Chibuike Eze Nwafor *

Department of Medicine, Cardiology Unit, University of Port Harcourt and University of Port Harcourt Teaching Hospital, Nigeria.

Otonye Briggs

Research Unit, Good Heart Medical Consultants, Port Harcourt, Nigeria.

*Author to whom correspondence should be addressed.


Background: The 24-hour Holter electrocardiogram is a valuable tool for the identification of ischaemic alterations, cardiac arrhythmias in hypertension, stroke and other cardiovascular conditions. Electrocardiographic (ECG) abnormalities and cardiac arrhythmias have been detected in 50% of stroke patients. However, literature in this area of research is limited in our environment. This study is aimed at describing the pattern of arrhythmia observed in patients with ischaemic stroke using 24-hour Holter ECG in our locality.

Methods: A total of 22 stroke subjects whose age ranged from 41 and 83 years were evaluated in GoodHeart Medical Consultants hospital for 24-hour ambulatory ECG (Holter ECG) from January 2015 – December 2016. The Holter ECG data was acquired using Schiller type (MT-101) Holter ECG machine.

Results: The study population consisted of 59.1% females and 40.9% males, with an average age of 66.95±12.32 years. Arrhythmias were more prevalent among females compared to males. However, bradycardia was more prevalent in males. Ventricular ectopics were the most common type of arrhythmia across both genders, with a higher prevalence in the older adult age group of 61-80 years.

Conclusion: The most common arrhythmia observed among the stroke subjects in Southern Nigeria is ventricular ectopics. This could be due to increase in age and severe neurological deficit which are independent predictors of arrhythmia onset and this was notably seen among the older subjects in the study. Extended cardiac monitoring such as Holter ECG is a well-accepted method for the identification of ECG abnormalities and the implementation of prompt treatment to reduce mortality. 

Keywords: 24-hour ambulatory holter electrocardiography, stroke, ischaemic, haemorrhage, cardiac arrhythmiasl Southern Nigeria

How to Cite

Nwafor, C. E., & Briggs , O. (2024). Pattern of Arrhythmia among Ischemic Stroke Patients on 24-hour Ambulatory Electrocardiography (Holter ECG) in South-South Nigeria. Asian Journal of Medicine and Health, 22(6), 147–152.


Download data is not yet available.


Osarenkhoe JO. Validation of OB Familoni ECG Abnormalities in Ischamic Stroke Cases. 2022;7:2456–4184.

Adeoye AM, Ogah OS, Ovbiagele B, Akinyemi R, Shidali V, Agyekum F, et al. Prevalence and Prognostic Features of ECG Abnormalities in Acute Stroke: Findings from the SIREN Study Among Africans. gh. 2017;12(2):99.

Manea M, Comsa M, Minca A, Dragos D, Popa C. Brain-heart axis - Review Article. J Med Life. 2015;8(3):266–71.

Purushothaman S, Salmani D, Prarthana KG, Bandelkar SMG, Varghese S. Study of ECG changes and its relation to mortality in cases of cerebrovascular accidents. J Nat Sci Biol Med. 2014;5(2):434–6.

Adebayo RA, Ikwu AN, Balogun MO, Akintomide AO, Mene-Afejuku TO, Adeyeye VO, et al. Evaluation of the indications and arrhythmic patterns of 24 hour Holter electrocardiography among hypertensive and diabetic patients seen at OAUTHC, Ile-Ife Nigeria. Diabetes, Metabolic Syndrome and Obesity. 2014; 7:565–70.

Chundusu CM, Akanbi MO, Onuh JA, Amusa GA, Danbauchi SS, Okeahialam BN. Descriptive evaluation of holter recordings at a teaching hospital in central Nigeria. Highland Medical Research Journal. 2015;15(2):59–62.

Carrarini C, Di Stefano V, Russo M, Dono F, Di Pietro M, Furia N, et al. ECG monitoring of post-stroke occurring arrhythmias: an observational study using 7-day Holter ECG. Sci Rep. 2022; 12(1):228.

Ruthirago D, Julayanont P, Tantrachoti P, Kim J, Nugent K. Cardiac Arrhythmias and Abnormal Electrocardiograms After Acute Stroke. The American Journal of the Medical Sciences. 2016;351(1):112–8.

Daniele O, Caravaglios G, Fierro B, Natalè E. Stroke and cardiac arrhythmias. Journal of Stroke and Cerebrovascular Diseases. 2002;11(1):28–33.

Fernández-Menéndez S, García-Santiago R, Vega-Primo A, González Nafría N, Lara-Lezama LB, Redondo-Robles L, et al. Cardiac arrhythmias in stroke unit patients. Evaluation of the cardiac monitoring data. Neurología (English Edition). 2016;31 (5):289–95.

Taggart P, Critchley H, Lambiase PD. Heart-brain interactions in cardiac arrhythmia. Heart. 2011;97(9):698–708.

Sörös P, Hachinski V. Cardiovascular and neurological causes of sudden death after ischaemic stroke. The Lancet Neurology. 2012;11(2):179–88.

Familoni OB, Odusan O, Ogun SA. The pattern and prognostic features of QT intervals and dispersion in patients with acute ischemic stroke. J Natl Med Assoc. 2006;98(11):1758–62.

Kuroda A, Kanda T, Sakai F. Gender differences in health‐related quality of life among stroke patients. Geriatrics Gerontology Int. 2006;6(3):165–73.

Kallmünzer B, Breuer L, Kahl N, Bobinger T, Raaz-Schrauder D, Huttner HB, et al. Serious Cardiac Arrhythmias After Stroke. Stroke. 2012;43(11):2892–7.

Frontera JA, Parra A, Shimbo D, Fernandez A, Schmidt JM, Peter P, et al. Cardiac Arrhythmias after Subarachnoid Hemorrhage: Risk Factors and Impact on Outcome. Cerebrovascular Diseases. 2008;26(1):71–8.

Ritter MA, Rohde A, Heuschmann PU, Dziewas R, Stypmann J, Nabavi DG, et al. Heart rate monitoring on the stroke unit. What does heart beat tell about prognosis? An observational study. BMC Neurol. 2011;11(1):47.

Abete P, Della-Morte D, Gargiulo G, Basile C, Langellotto A, Galizia G, et al. Cognitive impairment and cardiovascular diseases in the elderly. A heart–brain continuum hypothesis. Ageing Research Reviews. 2014;18:41–52.

del Barrio JL, Medrano MJ, Arce A, Bergareche A, Bermejo F, Díaz J, et al. [Prevalence of vascular risk factors among Spanish populations aged 70 years and over, as reported in door-to-door studies on neurological diseases]. Neurologia. 2007;22(3):138–46.

Fonarow GC, Reeves MJ, Zhao X, Olson DM, Smith EE, Saver JL, et al. Age-Related Differences in Characteristics, Performance Measures, Treatment Trends, and Outcomes in Patients With Ischemic Stroke. Circulation. 2010;121 (7):879–91.

Wang T, Li B, Gu H, Lou Y, Ning X, Wang J, et al. Effect of age on long-term outcomes after stroke with atrial fibrillation: a hospital-based follow-up study in China. Oncotarget. 2017;8(32): 53684–90.

Wolbrette D, Naccarelli G, Curtis A, Lehmann M, Kadish A. Gender differences in arrhythmias. Clinical Cardiology. 2002; 25(2):49–56.

Hilz MJ, Moeller S, Akhundova A, Marthol H, Pauli E, Fina PD, et al. High NIHSS Values Predict Impairment of Cardiovascular Autonomic Control. Stroke [Internet]. 2011 Jun [cited 2024 Mar 18];


Cardiac arrhythmias in acute stroke. [Internet]. [cited 2024 Mar 11].


Adams HP, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, et al. Guidelines for the Early Management of Adults with Ischemic Stroke. Stroke. 2007;38(5):1655–711.