Incidence of atrial fibrillation detected by implantable loop recorders in unexplained stroke

Abstract

Objectives: The usefulness of the implantable loop recorder (ILR) with improved atrial fibrillation (AF) detection capability (Reveal XT) and the factors associated with AF in the setting of unexplained stroke were investigated.Methods: A cohort study is reported of 51 patients in whom ILRs were implanted for the investigation of ischemic stroke for which no cause had been found (cryptogenic) following appropriate vascular and cardiac imaging and at least 24 hours of cardiac rhythm monitoring.Results: The patients were aged from 17 to 73 (median 52) years. Of the 30 patients with a shunt investigation, 22 had a patent foramen ovale (73.3%; 95% confidence interval [CI] 56.5%-90.1%). AF was identified in 13 (25.5%; 95% CI 13.1%-37.9%) cases. AF was associated with increasing age (p 5 0.

High Incidence of Atrial Fibrillation After Embolic Stroke of Undetermined Source in Posterior Cerebral Artery Territory

“…However, we used established criteria for the diagnosis of ESUS1 and have consecutively enrolled the patients; the mean follow‐up of patients was ≈1 year, with a minimum follow‐up of 3 months. Accordingly, the detection rate of subclinical AT/AF corresponded well to those of the previous publications, which suggests that the patient population in the present study should not be strongly biased 13, 14. Therefore, we believe the validity of our data in the present study.…”

Letter by Wachter et al Regarding Article, “Occult Atrial Fibrillation in Cryptogenic Stroke: Detection by 7-Day Electrocardiogram Versus Implantable Cardiac Monitors”

“…In addition, it would be very interesting to know whether patients who were later diagnosed with paroxysmal AF by means of the ILR already had short episodes of AF or supraventricular runs during the initial 7-day Holter ECG, as recently reported by Cotter et al 5 Such a finding might have a significant impact on selecting suitable patients for the implantation of ILR devices. …”

Long-term Cardiac Monitoring for Detection of Occult Atrial Fibrillation – A Tool to Prevent Secondary Stroke in Cryptogenic Stroke Patients

“…Further support for the utility of Reveal XT were provided by a cohort study by Cotter et al 23 in 51 stroke patients, all of whom had negative results for AF from rhythm monitoring with standard ECG and ≥24 hours of Holter monitoring. In this cohort, AF was detected by Reveal XT in 25.5 %.…”