Extended ECG monitoring with an implantable loop recorder in patients with cryptogenic stroke: time schedule, reasons for explantation and incidental findings (results from the TRACK-AF trial)

Abstract Introduction Long ambulatory ECG monitoring can be a useful component in the evaluation of the patient with unexplained syncope or syncope with suspected arrhythmic origin, as well as a sensitive tool for detecting asymptomatic spontaneous cardiac arrhythmias or conduction abnormalities in predisposed patients. Purpose To determine the diagnostic cost-effectiveness of the implantable loop recorder (ILR) in the origin of unexplained syncope in our center. Methods A retrospective observational study was carried out in a tertiary center, those patients with an ILR between August 2014 and March 2021 were included. Baseline characteristics of the population and their previous ECG, arrythmias detected during follow-up and pacemaker implant rate were evaluated. Results One hundred twenty-seven patients with a ILR were included (age 67 years, 49.6% males). Most often cause of ILR was unexplained syncope (90.6%) followed by monitoring after TAVI implant (3.9%). Normal LVEF (>50%) was present in 85.6%,and 75.6% had NYHA I functional class. 118 patients (92.9%) presented sinus rhythm at implant time, and 8 (6.3%) presented AF. 12.6% presented first degree atrioventricular (AV) block, 2 patients (1.6%) had presented previously Mobitz Type I AV block and one patient 2:1 block. Left bundle branch block (LBBB) was present in 13.4%,RBBB in 3.1%,LAFB in 9.4%, RBBB+LAFB in 11% and RBBB+LPFB in 2.4%. Median time of follow-up was 21 months. 3rd degree AV block was the most frequent arrhythmia detected (12.1%), followed by >3s pause (8%) and previously unknown AF (2.4%).The patients with syncope who suffered head trauma (33%) presented a higher rate of pacemaker (PCM) implant compared to those without head trauma: 31.6% vs 14.7%. In total,19.8% PCM rate implant during follow-up. No complications ILR related. Conclusion In conclusion, long home ECG monitoring with ILR is a powerful and helpful tool to find out or rule out potentially dangerous arrhythmias as cause of syncope, with no complications in our experience. FUNDunding Acknowledgement Type of funding sources: None. Baseline characteristics Arrhythmias detected during follow-up

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PMD35 Cost Analysis of an Implantable Loop Recorder, Reveal© XT, for the Diagnosis of Atrial Fibrillation in Patients Who Underwent Cryptogenic Stroke From the Perspective of a Tertiary Spanish Hospital

Value in Health ◽

10.1016/j.jval.2012.08.884 ◽

2012 ◽

Vol 15 (7) ◽

pp. A351

Author(s):

Y. Bravo ◽

B. Martí ◽

M.A. Grifols

Keyword(s):

Atrial Fibrillation ◽

Cost Analysis ◽

Cryptogenic Stroke ◽

Implantable Loop Recorder ◽

Loop Recorder ◽

Spanish Hospital

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Cryoballoon ablation for paroxysmal atrial fibrillation: mid-term outcome evaluated by ECG monitoring with an implantable loop recorder.

10.22541/au.160536983.36577660/v1 ◽

2020 ◽

Author(s):

Riccardo Maj ◽

Sergio De Ceglia ◽

Elena Piazzi ◽

Mattia Pozzi ◽

Elisabetta Montemerlo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Cryoballoon Ablation ◽

Implantable Loop Recorder ◽

Ecg Monitoring ◽

Loop Recorder ◽

Term Outcome

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Incidence and Predictors of Very Late Recurrence of Atrial Fibrillation Following Cryoballoon Pulmonary Vein Isolation

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.120.008646 ◽

2020 ◽

Vol 13 (9) ◽

Author(s):

Dan L. Musat ◽

Nicolle S. Milstein ◽

Advay Bhatt ◽

Tina C. Sichrovsky ◽

Mark W. Preminger ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Late Recurrence ◽

Implantable Loop Recorder ◽

Ecg Monitoring ◽

Loop Recorder ◽

Risk Patients ◽

First Recurrence

Background: A very late recurrence (VLR) of atrial fibrillation (AF) is considered present when the first recurrence of AF occurs ≥12 months following ablation. Prior studies characterizing VLR have not used an implantable loop recorder for ECG monitoring. Thus, it is unknown whether VLR truly occurs or whether these patients have simply had unrecognized AF. Our objective was to assess the incidence and predictors of VLR in patients who underwent cryoballoon pulmonary vein isolation alone, had an implantable loop recorder, and were confirmed AF free for at least 1 year. Methods: We enrolled consecutive patients with paroxysmal or persistent AF who underwent cryoballoon pulmonary vein isolation and had an implantable loop recorder implanted <3 months post-ablation. Patients free of AF 1 year post-ablation were followed prospectively for recurrent AF. All AF episodes were adjudicated. Results: We included 188 patients (66±10 years; 116 [62%] men; 102 [54%] paroxysmal AF; CHA 2 DS 2 -VASc, 2.6±1.7). After 1 year post-pulmonary vein isolation, 93 (49%) patients remained AF free. During subsequent follow-up, 30 (32%) patients had VLR of AF. The only independent risk factor for VLR was an elevated CHA 2 DS 2 -VASc score (hazard ratio, 1.317 [95% CI, 1.033–1.6979]; P =0.026). Patients with CHA 2 DS 2 -VASc score ≥4 represented a quarter of the population and were at the highest risk. Conclusions: Our data using implantable loop recorders for continuous ECG monitoring post-AF ablation show that VLR occurs in a third of patients after an apparently successful cryoballoon pulmonary vein isolation procedure. Additional strategies are needed to ensure long-term freedom from AF recurrences in these high-risk patients.

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