Predictors of atrial fibrillation on implantable cardiac monitoring for cryptogenic stroke

Desai, Amar D.; Howe, Emily; Coromilas, Ellie J.; Zhang, Yiyi; Dizon, José; Willey, Joshua Z.; Biviano, Angelo; Garan, Hasan; Wan, Elaine

doi:10.1007/s10840-021-00985-1

Cited by 8 publications

(9 citation statements)

References 22 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%

“…For ESUS patients, the pooled rate was 13.5% (95% CI 6.5–22.6), and globally, the AF detection with non-implantable devices was 12.3% (95% CI 9.4–15.4). 32,33,36,39,43–46,48–54,56–67,69,70,100…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, left ventricular abnormalities (left ventricular ejection fraction depression, left ventricular hypertrophy) have been also related with a higher risk of AF detection, probably because of the known relationship between previous cardiac disease and subclinical AF 67,110 (Figures e11 and e12 in the Supplemental File).…”

Section: Resultsmentioning

confidence: 99%

“…Several observational single-arm studies, 20,28,31,[35][36][37]42,44,45,48,[54][55][56][57][58][59]62,64,65,[67][68][69][70]73,[89][90][91] have studied additional outpatient ECG monitoring, with a wide range of monitoring initiation, duration and type of monitoring systems (Figure 9). The median rate of any AF detection in patients with cryptogenic stroke or TIA with out-patient AF screening was 19.2% (95% CI 15-23.8).…”

Section: CXVImentioning

confidence: 99%

“…For ESUS patients, the pooled rate was 13.5% (95% CI 6.5-22.6), and globally, the AF detection with non-implantable devices was 12.3% (95% CI 9.4-15.4). 32,33,36,39,[43][44][45][46][48][49][50][51][52][53][54][56][57][58][59][60][61][62][63][64][65][66][67]69,70,100 Additional information. The provided data identify an increased detection of AF with the use of implantable monitoring devices as compared with non-invasive strategies.…”

Section: Outcome: Detection Of Subclinical Afmentioning

confidence: 99%

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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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