Paroxysmal atrial fibrillation occurs often in cryptogenic ischaemic stroke. Final results from the <scp>SURPRISE</scp> study

Christensen, Louisa; Krieger, Derk; Højberg, Søren; Pedersen, Ole Dyg; Karlsen, Finn Michael; Jacobsen, Mia Ravn; Worck, René; Nielsen, Henrik; Ægidius, K.; Jeppesen, Lise Leth; Rosenbaum, Sverre; Marstrand, Jacob; Christensen, Hanne

doi:10.1111/ene.12400

Cited by 113 publications

(92 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…They offer greatly extended monitoring periods and high detection rates. 26 For the majority of patients, however, our trial suggests that a relatively brief duration of noninvasive monitoring may be sufficient for routine application, with 88% of sustained PAF identified within 72 hours. Excellent reporting agreement between treating stroke physicians and the electrocardiology laboratory facilitates immediacy of clinical decisions and could limit costs.…”

Section: Strokementioning

confidence: 81%

“…12 The AM compared very favorably against rates reported for 24-hour Holter monitoring 12 or repeated 12-lead ECGs 24 and achieved similar detection rates to extended-duration Holter monitoring, 23 automated software-assisted continuous electrophysiological monitoring, 25 and implantable cardiac-event recorders. 26 Thus, guideline-based practice underdetects AF. In contrast, we detected sustained PAF episodes that justify anticoagulation in an additional 16% of patients, within 14 days.…”

Section: Strokementioning

confidence: 99%

See 1 more Smart Citation

Noninvasive Cardiac Event Monitoring to Detect Atrial Fibrillation After Ischemic Stroke

Higgins

Macfarlane

Dawson

et al. 2013

Stroke

120

View full text Add to dashboard Cite

Background and Purpose— Atrial fibrillation (AF) elevates risk of recurrent stroke but is incompletely identified by standard investigation after stroke, though detection rates correlate with monitoring duration. We hypothesized that 7 days of noninvasive cardiac-event monitoring early after stroke would accelerate detection of AF and thus uptake of effective therapy. Methods— We performed a pragmatic randomized trial with objective outcome assessment among patients presenting in sinus rhythm with no AF history, within 7 days of ischemic stroke symptom onset. Patients were randomized to standard practice investigations (SP) to detect AF, or SP plus additional monitoring (SP-AM). AM comprised 7 days of noninvasive cardiac-event monitoring reported by an accredited cardiac electrocardiology laboratory. Primary outcome was detection of AF at 14 days. Results— One-hundred patients were enrolled from 2 centers. Within 14 days of stroke, sustained paroxysms of AF were detected in 18% of patients undergoing SP-AM versus 2% undergoing SP ( P <0.05). Paroxysms of any-duration were detected in 44% of patients undergoing SP-AM versus 4% undergoing SP ( P <0.001). These differences persisted at 90 days. Anticoagulant therapy was commenced within 14 days in 16% of SP-AM patients versus none randomized to SP ( P <0.01). This difference persisted to 90 days (22% versus 6%; P <0.05). Conclusions— Routine noninvasive cardiac-event monitoring after acute stroke enhances detection of paroxysmal AF and early anticoagulation. Extended monitoring should be offered to all eligible patients soon after acute stroke. Guidelines on investigation for AF in stroke patients could be strengthened. Clinical Trial Registration— URL: http://www.controlled-trials.com/isrctn/ . Unique identifier: ISRCTN97412358.

show abstract

Section: Strokementioning

confidence: 81%

Section: Strokementioning

confidence: 99%

Noninvasive Cardiac Event Monitoring to Detect Atrial Fibrillation After Ischemic Stroke

Higgins

Macfarlane

Dawson

et al. 2013

Stroke

120

View full text Add to dashboard Cite

show abstract

“…16,17 Long-term continuous monitoring using insertable cardiac monitors (ICMs) has been shown to be the most comprehensive method of detecting paroxysmal and asymptomatic AF in CS patients. 10,[19][20][21][22] The incidence of AF detected by ICMs in this population ranges from 16% to 33.7%, depending on the episode duration definition, the length of monitoring, and patient selection. 6 OAC therapy is highly effective in reducing recurrent stroke in patients with AF.…”

Section: Long-term Monitoring Of Atrial Fibrillationmentioning

confidence: 99%

Uncovering Atrial Fibrillation Beyond Short-Term Monitoring in Cryptogenic Stroke Patients

Brachmann

Morillo

Sanna

et al. 2016

Circ: Arrhythmia and Electrophysiology

158

View full text Add to dashboard Cite

Background— Atrial fibrillation (AF) can be a cause of previously diagnosed cryptogenic stroke. However, AF can be paroxysmal and asymptomatic, thereby making detection with routine ECG methods difficult. Oral anticoagulation is highly effective in reducing recurrent stroke in patients with AF, but its initiation is dependent on the detection of AF. Cryptogenic Stroke and Underlying Atrial Fibrillation (CRYSTAL AF) is the first randomized study to report the detection of AF in cryptogenic stroke patients using continuous long-term monitoring via insertable cardiac monitors (ICM). Methods and Results— Patients with prior cryptogenic stroke were randomized to control (n=220) or ICM (n=221) and followed for ≤36 months. Cumulative AF detection rates in the ICM arm increased progressively during this period (3.7%, 8.9%, 12.4%, and 30.0% at 1, 6, 12, and 36 months, respectively), but remained low in the control arm (3.0% at 36 months). This resulted in oral anticoagulation prescription in 94.7% of ICM patients with AF detected at 6 months, 96.6% at 12 months, and 90.5% at 36 months. Among ICM patients with AF detected, the median time to AF detection was 8.4 months, 81.0% of first AF episodes were asymptomatic, and 94.9% had at least 1 day with >6 minutes of AF. Conclusions— Three-year monitoring by ICM in cryptogenic stroke patients demonstrated a significantly higher AF detection rate compared with routine care. Given the frequency of asymptomatic first episodes and the long median time to detection, these findings highlight the limitations of using traditional AF detection methods. The majority of patients with AF were prescribed oral anticoagulation therapy. Clinical Trial Registration— Clinicaltrials.gov ; Unique identifier: NCT00924638.

show abstract

“…However, numerous small, singlecenter studies have demonstrated that significant proportions of patients with strokes initially believed to be cryptogenic actually have episodes of occult AF detected beyond 30 days of monitoring via even more extensive rhythm surveillance with insertable cardiac monitors (ICMs) [13][14][15][16][17] .…”

mentioning

confidence: 99%

Real-World Experience with Insertable Cardiac Monitors to Find Atrial Fibrillation in Cryptogenic Stroke

et al. 2015

View full text Add to dashboard Cite

Background: The characteristics of atrial fibrillation (AF) episodes in cryptogenic stroke patients have recently been explored in carefully selected patient populations. However, the incidence of AF among a large, real-world population of patients with an insertable cardiac monitor (ICM) placed for the detection of AF following a cryptogenic stroke has not been investigated. Methods: Patients in the de-identified Medtronic DiscoveryLink™ database who received an ICM (Reveal LINQ™) for the purpose of AF detection following a cryptogenic stroke were included. AF detection rates (episodes ≥2 min) were quantified using Kaplan-Meier survival estimates at 1 and 6 months and compared to the CRYSTAL AF study at 6 months. The time to AF detection and maximum duration of AF episodes were also analyzed. Results: A total of 1,247 patients (age 65.3 ± 13.0 years) were followed for 182 (IQR 182-182) days. A total of 1,521 AF episodes were detected in 147 patients, resulting in AF detection rates of 4.6 and 12.2% at 30 and 182 days, respectively, and representing a 37% relative increase over that reported in the CRYSTAL AF trial at 6 months. The median time to AF detection was 58 (IQR 11-101) days and the median duration of the longest detected AF episode was 3.4 (IQR 0.4-11.8) h. Conclusions: The real-world incidence of AF among patients being monitored with an ICM after a cryptogenic stroke validates the findings of the CRYSTAL AF trial and suggests that continuous cardiac rhythm monitoring for periods longer than the current guideline recommendation of 30 days may be warranted in the evaluation of patients with cryptogenic stroke.

show abstract

Paroxysmal atrial fibrillation occurs often in cryptogenic ischaemic stroke. Final results from the SURPRISE study

Abstract: One in five patients with CS had PAF, which occurred at low burden and long after stroke. Future studies should determine the role of implantable cardiac monitors after stroke and determine the potential therapeutic benefit of OAC treatment of patients with PAF.

Cited by 113 publications

References 27 publications

Noninvasive Cardiac Event Monitoring to Detect Atrial Fibrillation After Ischemic Stroke

Noninvasive Cardiac Event Monitoring to Detect Atrial Fibrillation After Ischemic Stroke

Uncovering Atrial Fibrillation Beyond Short-Term Monitoring in Cryptogenic Stroke Patients

Real-World Experience with Insertable Cardiac Monitors to Find Atrial Fibrillation in Cryptogenic Stroke

Contact Info

Product

Resources

About