Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan 28:12:816511.
doi: 10.3389/fneur.2021.816511. eCollection 2021.

Neurologist-Led Management of Implantable Loop-Recorders After Embolic Stroke of Undetermined Source

Slaven Pikija  1 , Cornelia Rösler  1 , Ursula Leitner  1 , Thomas Zellner  1 , Nele Bubel  1 , Bernhard Ganser  1 , Constantin Hecker  1 , Johannes Sebastian Mutzenbach  1
Affiliations

Neurologist-Led Management of Implantable Loop-Recorders After Embolic Stroke of Undetermined Source

Slaven Pikija et al. Front Neurol. .

Abstract

Introduction: Upon completion of the workup for stroke, etiology cannot be identified in approximately one-third of the patients, with an embolic stroke of undetermined source (ESUS) accounting for around 50% of these cryptogenic etiologies. Whether management of complex long-term monitoring in order to detect suspected atrial fibrillation (AFib) could be initiated and managed through a neurologist is not sufficiently investigated.

Patients and methods: We recruited all consecutive patients with ESUS who received implantation after neurological adjudication of Reveal LINQ® loop recorder between January 2016 and July 2020. We collected demographic, clinical, heart- and neuroimaging, laboratory, and electrocardiographic data assessed on prolonged baseline ECG monitoring, number of supraventricular (SVEs) and ventricular (VEs) extrasystolic complexes, and from preimplantation ECG-PQ interval. AFib detection was manually supervised and determined positive when the duration was over 120 s.

Results: We followed a total of 131 patients for a median of 504 days. There were 45 (34%) manually verified AFib diagnoses. In univariate analysis, earlier implantation after ESUS was associated with AFib detection (13 vs. 31 days, p = 0.011). In multivariate analysis, increased rate of AFib was associated with a more prolonged PQ interval (per 50-ms increase) (HR 1.99, 95% CI 1.39-2.85) and number of SVEs (HR 1.29, 95% CI 1.05-1.57) measured on pre-implantation ECG.

Conclusion: We observed similar predictors for Afib after ESUS, albeit with higher frequency than previously reported. This study suggests that the neurologist-led decision, management, and evaluation of ILR after ESUS is feasible.

Keywords: PQ interval; atrial fibrillation; embolic stroke of undetermined source; ischemic stroke (IS); loop recorder.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Biphasic distribution of days to atrial fibrillation detection in 45 patients with Reveal LINQ® Medtronic implantable recorder. The vertical dotted line represents the median (65 days).
Figure 2
Figure 2
Probability of having atrial fibrillation in 131 patients with the implanted loop recorder device. The vertical dashed line represents median days to atrial fibrillation detection. Crosses represent censored observations.
See this image and copyright information in PMC

References

    1. Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019 (2020). Available online at: http://ghdx.healthdata.org/gbd (accessed Jul 22, 2021). - PMC - PubMed
    1. O'Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. (2016) 388:761–75. 10.1016/S0140-6736(16)30506-2 - DOI - PubMed
    1. Hart RG, Diener HC, Coutts SB, Easton JD, Granger CB, O'Donnell MJ, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. (2014) 13:429–38. 10.1016/S1474-4422(13)70310-7 - DOI - PubMed
    1. Hart RG, Sharma M, Mundl H, Kasner SE, Bangdiwala SI, Berkowitz SD, et al. Rivaroxaban for stroke prevention after embolic stroke of undetermined source. N Engl J Med. (2018) 378:2191–201. 10.1056/nejmoa1802686 - DOI - PubMed
    1. Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. (2021) 52:e364–e467. 10.1161/STR.0000000000000375 - DOI - PubMed

LinkOut - more resources