Detection of atrial fibrillation using an implantable loop recorder following cryptogenic stroke: implications for post-stroke electrocardiographic monitoring

Milstein, N; Musat, Dan; Allred, James; Seiler, Amber; Pimienta, Jacqueline; Oliveros, Susan; Bhatt, Advay G.; Preminger, Mark; Sichrovsky, Tina; Shaw, Richard E.; Mittal, Suneet

doi:10.1007/s10840-019-00628-6

Cited by 18 publications

(10 citation statements)

References 19 publications

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“…A pooled analysis of published single arm studies demonstrated that the rate of detected AF increases with the duration of monitoring, from about 8.9% at 1 month to 17.9% at 6 months, 22.3% at 12 months and 25.2% at 36 months (Figures 3–6). 24–73…”

Section: Resultsmentioning

confidence: 99%

European Stroke Organisation (ESO) guideline on screening for subclinical atrial fibrillation after stroke or transient ischaemic attack of undetermined origin

Rubiera

Aires

Antonenko

et al. 2022

European Stroke Journal

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We aimed to provide practical recommendations for the screening of subclinical atrial fibrillation (AF) in patients with ischaemic stroke or transient ischaemic attack (TIA) of undetermined origin. These guidelines are based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Five relevant Population, Intervention, Comparator, Outcome questions were defined by a multidisciplinary module working group (MWG). Longer duration of cardiac rhythm monitoring increases the detection of subclinical AF, but the optimal monitoring length is yet to be defined. We advise longer monitoring to increase the rate of anticoagulation, but whether longer monitoring improves clinical outcomes needs to be addressed. AF detection does not differ from in- or out-patient ECG-monitoring with similar monitoring duration, so we consider it reasonable to initiate in-hospital monitoring as soon as possible and continue with outpatient monitoring for more than 48h. Although insertable loop recorders (ILR) increase AF detection based on their longer monitoring duration, comparison with non-implantable ECG devices for similar monitoring time is lacking. We suggest the use of implantable devices, if feasible, for AF detection instead of non- implantable devices to increase the detection of subclinical AF. There is weak evidence of a useful role for blood, ECG, and brain imaging biomarkers for the identification of patients at high risk of AF. In patients with patent foramen ovale, we found insufficient evidence from RCT, but prolonged cardiac monitoring in patients >55 years is advisable for subclinical AF detection. To conclude, in adult patients with ischaemic stroke or TIA of undetermined origin, we recommend longer duration of cardiac rhythm monitoring of more than 48h and if feasible with IRL to increase the detection of subclinical AF.

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Section: Resultsmentioning

confidence: 99%

European Stroke Organisation (ESO) guideline on screening for subclinical atrial fibrillation after stroke or transient ischaemic attack of undetermined origin

Rubiera

Aires

Antonenko

et al. 2022

European Stroke Journal

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“…The AF rate findings of our study are consistent with results from similar CS studies, published after our study was intended, using the same device ( Figure 3 ). 7 , 13 – 18 …”

Section: Discussionmentioning

confidence: 99%

Atrial fibrillation in cryptogenic stroke and TIA patients in The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study: Main results

Ratajczak-Tretel

Lambert

Al-Ani

et al. 2022

European Stroke Journal

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Introduction: Secondary stroke prevention depends on proper identification of the underlying etiology and initiation of optimal treatment after the index event. The aim of the NOR-FIB study was to detect and quantify underlying atrial fibrillation (AF) in patients with cryptogenic stroke (CS) or transient ischaemic attack (TIA) using insertable cardiac monitor (ICM), to optimise secondary prevention, and to test the feasibility of ICM usage for stroke physicians. Patients and methods: Prospective observational international multicenter real-life study of CS and TIA patients monitored for 12 months with ICM (Reveal LINQ) for AF detection. Results: ICM insertion was performed in 91.5% by stroke physicians, within median 9 days after index event. Paroxysmal AF was diagnosed in 74 out of 259 patients (28.6%), detected early after ICM insertion (mean 48 ± 52 days) in 86.5% of patients. AF patients were older (72.6 vs 62.2; p < 0.001), had higher pre-stroke CHA₂DS₂-VASc score (median 3 vs 2; p < 0.001) and admission NIHSS (median 2 vs 1; p = 0.001); and more often hypertension ( p = 0.045) and dyslipidaemia ( p = 0.005) than non-AF patients. The arrhythmia was recurrent in 91.9% and asymptomatic in 93.2%. At 12-month follow-up anticoagulants usage was 97.3%. Discussion and conclusions: ICM was an effective tool for diagnosing underlying AF, capturing AF in 29% of the CS and TIA patients. AF was asymptomatic in most cases and would mainly have gone undiagnosed without ICM. The insertion and use of ICM was feasible for stroke physicians in stroke units.

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“…A study performed by Sanna et al., using an insertable cardiac monitor demonstrated a median of 84 days from randomisation to AF detection [ 23 ]. Newly published studies used implantable loop recorders and resulted in an average time to first AF episode of 108 days [ 24 ] and 121 days [ 25 ]. Overall, these findings are consistent with our results and suggest that performing an outpatient delayed cardiac monitoring with relation to the stroke did not lower the detection rates.…”

Section: Discussionmentioning

confidence: 99%

Detection of occult atrial fibrillation with 24-hour ECG after cryptogenic acute stroke or transient ischaemic attack: A retrospective cross-sectional study in a primary care database in Israel

Liran¹,

Banon

Grossman

2021

European Journal of General Practice

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Detection of atrial fibrillation using an implantable loop recorder following cryptogenic stroke: implications for post-stroke electrocardiographic monitoring

Cited by 18 publications

References 19 publications

European Stroke Organisation (ESO) guideline on screening for subclinical atrial fibrillation after stroke or transient ischaemic attack of undetermined origin

European Stroke Organisation (ESO) guideline on screening for subclinical atrial fibrillation after stroke or transient ischaemic attack of undetermined origin

Atrial fibrillation in cryptogenic stroke and TIA patients in The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study: Main results

Detection of occult atrial fibrillation with 24-hour ECG after cryptogenic acute stroke or transient ischaemic attack: A retrospective cross-sectional study in a primary care database in Israel

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