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. 2020 Feb;27(2):244-250.
doi: 10.1111/ene.14061. Epub 2019 Sep 18.

Ultra-early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic stroke

E Cuadrado-Godia  1 , B Benito  2   3 , A Ois  1 , E Vallès  2 , A Rodríguez-Campello  1 , E Giralt-Steinhauer  1 , S Cabrera  4 , O Alcalde  5 , J Jiménez-López  2 , J Jiménez-Conde  1 , J Martí-Almor  2 , J Roquer  1
Affiliations

Ultra-early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic stroke

E Cuadrado-Godia et al. Eur J Neurol. 2020 Feb.

Abstract

Background and purpose: Subclinical atrial fibrillation (AF) is known to underlie a number of cases of cryptogenic stroke (CrS). However, there is need to define the most effective strategy for AF detection. The diagnostic usefulness was analysed of a strategy based on ultra-early continuous monitoring in patients with CrS in terms of AF detection, oral anticoagulation treatment and stroke recurrence, in comparison to a standard outpatient strategy.

Methods: Patients with ischaemic stroke of undetermined origin and confirmed to be cryptogenic after extensive work-up were searched for AF with (i) a conventional strategy (historical cohort, n = 101) with serial electrocardiograms and 24-h Holter monitoring or (ii) an ultra-early monitoring strategy with insertable cardiac monitor (ICM) implanted before discharge (prospective cohort, n = 90). AF episodes lasting >1 min, anticoagulant treatment and stroke recurrence were recorded.

Results: During admission, AF was similarly detected in both cohorts (24% of patients). After discharge (mean follow-up 30 ± 10 months), AF detection rates were 17/80 (21.3%) and 38/65 (58.5%) for patients in the conventional versus the ultra-early ICM group (P < 0.001). Up to 41% of AF cases in the ICM cohort were detected within the first month. Oral anticoagulation was initiated in 37.6% versus 65.5% (P < 0.001) and stroke recurrence was recorded in 10.9% versus 3.3% (P 0.04) in the conventional versus the ICM cohort.

Conclusions: Pre-discharge ICM implant allows detection of AF during follow-up in up to 58% of selected patients with CrS. Compared to a conventional strategy, ultra-early ICM implant results in higher anticoagulation rates and a decrease in stroke recurrence.

Keywords: atrial fibrillation; cardiac monitor; cryptogenic stroke; stroke recurrence.

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References

    1. Saver JL. Cryptogenic stroke. N Engl J Med 2016; 374: 2065-2074.
    1. Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ. An evidence-based causative classification system for acute ischemic stroke. Ann Neurol 2005; 58: 688-697.
    1. Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke: a Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49: e46-e110.
    1. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007; 146: 857-867.
    1. Albers GW, Bernstein RA, Brachmann J, et al. Heart rhythm monitoring strategies for cryptogenic stroke: 2015 diagnostics and monitoring stroke focus group report. J Am Heart Assoc 2015; 5: 1-11.

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