OBJECTIVES: Prolonged brief intermittent arrhythmia screening has been suggested  to substantially  improve  detection of silent paroxysmal atrial fibrillation (AF) in patients with a recent ischemic stroke/TIA. The purpose of this study was to estimate the cost-effectiveness of two screening methods for detection of silent AF , brief intermittent long-term  ECG recordings  at regular time intervals and short-term 24-hours continuous ECG (Holter-ECG) and to compare them to a no screening alternative in patients with a recent ischemic stroke METHODS: The long-term (20 year) costs and effects of brief intermittent long-term ECG recordings at regular time intervals and short term continuous ECG  are estimated with a decision analytic model combining the result of a clinical study and epidemiological data. The structure of a cost-effectiveness analysis was used in this study. The short term decision tree model analyzed the screening procedure until the onset of anticoagulant treatment. The second part of the decision model follows a Markov design simulating the patients for 20 years. RESULTS: Continuous 24 h ECG recording was dominated by intermittent ECG due to lower sensitivity and higher costs. The base case analysis compared intermittent-ECG screening with no screening of patients with recent stroke. The implementation of the screening program on 1000 patients resulted in 10,9 avoided strokes and the gain of 29,2 life years or 22,7 QALYs and cost savings of €55 000. CONCLUSIONS: Screening of silent AF by intermittent ECG recordings in patients with a recent ischaemic stroke is cost-effective use of health care resources saving costs, lives and quality of life.