Objective Measures of Atrial Fibrillation Persistence in Patients with Implantable Cardiac Rhythm Monitoring Devices

Abstract Background There are only limited options for long-term cardiac monitoring devices readily available in clinical practice for outpatients. Holter monitoring devices are limited by the uncomfort of wires and patches, the small number of leads for analysis, the quality of recordings or the monitoring duration while insertable cardiac monitors are costly and exposed to potential local complication. Purpose To describe a single center experience with a novel wearable device for cardiac rhythm monitoring. Methods The Cardioskin™ system is a patch-free, wire-free, wearable device with rechargeable batteries that provides a high quality 15-lead electrocardiogram monitoring over 1 month (Figure 1). Data are sent using a mobile application downloaded in the patient smartphone to a central Corelab where they can be interpreted by an expert and/or the prescribing physician. An alarm signal is readily available within the Cardioskin™ device, to allow patients to indicate the presence of symptoms. In this single center retrospective registry, we provide a first report of the use of this novel device in real world practice, with indication and duration of cardiac monitoring left at the physicans “discretion”. Results From January 2019 to December 2019, the Cardioskin™ system was prescribed in 60 patients for an overall median duration of 26.5 (14–32) days. The mean age of the patients was 45±12.2 years and 24 (40%) were male. Indications for cardiac monitoring were post-Stroke, palpitation, syncope and cardiomyopathy assessment in 56%, 30%, 7% and 7% of the cases, respectively. A sustained (>30 seconds) supraventricular tachycardia was detected in 4 cases, including one case of atrial fibrillation, two case of atrial tachycardia and on case of junctional tachycardia. Unsustained ventricular tachycardia and atrial fibrillation burst were detected in another 2 cases (Figure 1). There was no reported case of skin irritation by the Cardioskin™ system or abrupt interruption of the monitoring by the patients. Conclusion The Cardioskin™ system is a novel, discreet and comfortable cardiac rhythm wearable long-term monitoring device which can be used in clinical practice for broad diagnostic indications. Figure 1. Cardioskin system Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): ACTION coeur

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Follow-up after surgical ablation therapy for atrial fibrillation (AF) using an implantable cardiac rhythm monitoring device (ICM)

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0032-1332466 ◽

2013 ◽

Vol 61 (S 01) ◽

Author(s):

A Kowert ◽

C Vicol ◽

C Hagl ◽

G Juchem

Keyword(s):

Atrial Fibrillation ◽

Cardiac Rhythm ◽

Monitoring Device ◽

Surgical Ablation ◽

Ablation Therapy ◽

Rhythm Monitoring

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Recurrence rate of atrial fibrillation after the first clinical episode: A prospective evaluation using continuous cardiac rhythm monitoring

Clinical Cardiology ◽

10.1002/clc.22904 ◽

2018 ◽

Vol 41 (5) ◽

pp. 594-600 ◽

Cited By ~ 2

Author(s):

Emmanuel N. Simantirakis ◽

Panteleimon E. Papakonstantinou ◽

Emmanuel Kanoupakis ◽

Gregory I. Chlouverakis ◽

Stylianos Tzeis ◽

...

Keyword(s):

Atrial Fibrillation ◽

Recurrence Rate ◽

Cardiac Rhythm ◽

Prospective Evaluation ◽

Clinical Episode ◽

Rhythm Monitoring

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Abstract 25: Paroxysmal Atrial Fibrillation is Common in Patients With Defined Etiology for Stroke: Prolonged Monitoring of Cardiac Rhythm for Detection of Atrial Fibrillation After a Cerebral Ischemic Event (PEAACE) Study

Stroke ◽

10.1161/str.45.suppl_1.25 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Esseddeeg M Ghrooda ◽

Peter Dobrowolski ◽

Ghazala Basir ◽

Ibrahim Yaseen ◽

Nazim khan ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Cardiac Rhythm ◽

Previous History ◽

Cryptogenic Stroke ◽

Predictive Score ◽

Stroke Patients ◽

Similar Frequency ◽

Stroke Team ◽

Rhythm Monitoring

Introduction: Atrial fibrillation (AF) related cardioembolic stroke accounts for over 20% of ischemic stroke. Recent reports using prolonged cardiac rhythm monitoring (PCRM) in cryptogenic stroke reveal paroxysmal AF (PAF) in an additional 20% of patients. We report our findings with PCRM in patients with and without cryptogenic stroke patients in whom an initial 24-h Holter was negative. Methods: Patients admitted to the stroke service with no previous history of AF and no AF on Holter monitoring were enrolled for 3 weeks of PCRM. We used a PAF predictive score to determine the risk of the arrhythmia. All studies were interpreted by the stroke team prior to final review by the cardiologist. Results: Between Sept 2012 and June 2013, 96 patients were evaluated. Over all PAF was diagnoses in 37.5 % of patients. PAF was diagnosed in 32% of patients with cryptogenic stroke and 36 % of patients where an additional etiology may account for the stroke diagnosis. The AF prediction score was not useful in the recognition of patients that were more likely to be at risk for AF. 96 of 98 recordings were correctly identified by the stroke team prior to final diagnosis by the cardiologist. Interpretation: PAF is more common in stroke patients than was previously suspected. It occurs with similar frequency in patients with and without cryptogenic stroke. Our data strongly supports the need for prolonged cardiac rhythm monitoring in all stroke patients to diagnose this important preventable cause of ischemic stroke.

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Cost-Effectiveness of Extended Electrocardiogram Monitoring for Atrial Fibrillation After Stroke

Stroke ◽

10.1161/strokeaha.120.029340 ◽

2020 ◽

Vol 51 (7) ◽

pp. 2244-2248 ◽

Cited By ~ 3

Author(s):

Derek S. Chew ◽

Elissa Rennert-May ◽

Eldon Spackman ◽

Daniel B. Mark ◽

Derek V. Exner

Keyword(s):

Atrial Fibrillation ◽

Cost Effectiveness ◽

Standard Care ◽

Cryptogenic Stroke ◽

Cost Utility ◽

Economic Evaluations ◽

Ecg Monitoring ◽

The Cost ◽

Monitoring Devices ◽

Rhythm Monitoring

Background and Purpose: Management of cryptogenic stroke involves the identification of modifiable risk factors, such as atrial fibrillation (AF). Extended rhythm monitoring increases AF detection rates but at an increased device cost compared with conventional Holter monitoring. The objective of the study was to identify and synthesize the existing literature on the cost-effectiveness of prolonged rhythm monitoring devices for AF detection in cryptogenic stroke. Methods: We conducted a systematic review of available economic evaluations of prolonged ECG monitoring for AF detection following cryptogenic stroke compared with standard care. Results: Of the 530 unique citations, 8 studies assessed the cost-utility of prolonged ECG monitoring compared with standard care following cryptogenic stroke. The prolonged ECG monitoring strategies included 7-day ambulatory monitoring, 30-day external loop recorders or intermittent ECG monitoring, and implantable loop recorders. The majority of cost-utility analyses reported incremental cost-effectiveness ratios below $50 000 per QALY gained; and two studies reported a cost-savings. Conclusions: There is limited economic literature on the cost-effectiveness of extended ECG monitoring devices for detection of atrial fibrillation in cryptogenic stroke. In patients with cryptogenic stroke, extended ECG monitoring for AF detection may be economically attractive when traditional willingness-to-pay thresholds are adopted. However, there was substantial variation in the reported ICERs. The direct comparison of cost-effectiveness across technologies is limited by heterogeneity in modeling assumptions.

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Detection of Paroxysmal Atrial Fibrillation in Stroke/Tia Patients

Stroke Research and Treatment ◽

10.1155/2013/840265 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Muhib Khan ◽

Daniel J. Miller

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Cardiac Rhythm ◽

Genetic Factors ◽

Arrhythmia Detection ◽

Ischemic Attack ◽

Event Definition ◽

Possible Cause ◽

Rhythm Monitoring

One-third of stroke and transient ischemic attack (TIA) are cryptogenic, and paroxysmal atrial fibrillation (PAF) has been suggested as a possible cause for these cryptogenic strokes. Multiple studies have recently evaluated long-term cardiac rhythm monitoring with good yield for PAF. The duration of monitoring varies between studies as well as the qualifying event definition. Moreover, the clinical significance of very brief atrial fibrillation events is unclear in the literature. This paper provides an overview of current advances in the detection of paroxysmal atrial fibrillation, the clinical and genetic factors predictive of arrhythmia detection, and the therapeutic dilemma concerning this approach.

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Long-term outcomes after surgical ablation for atrial fibrillation in patients with continuous heart rhythm monitoring devices

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivv248 ◽

2015 ◽

pp. ivv248 ◽

Cited By ~ 3

Author(s):

Efstratios I. Charitos ◽

Paul D. Ziegler ◽

Ulrich Stierle ◽

Bernhard Graf ◽

Hans-Hinrich Sievers ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Rhythm ◽

Long Term Outcomes ◽

Surgical Ablation ◽

Monitoring Devices ◽

Rhythm Monitoring

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Blood Biomarkers of Heart Failure and Hypercoagulation to Identify Atrial Fibrillation–Related Stroke

Stroke ◽

10.1161/strokeaha.119.025339 ◽

2019 ◽

Vol 50 (8) ◽

pp. 2223-2226 ◽

Cited By ~ 2

Author(s):

Markus Kneihsl ◽

Thomas Gattringer ◽

Egbert Bisping ◽

Daniel Scherr ◽

Reinhard Raggam ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Negative Predictive Value ◽

Predictive Value ◽

Cardiac Rhythm ◽

Blood Biomarkers ◽

Stroke Patients ◽

At Iii ◽

D Dimer ◽

Rhythm Monitoring

Background and Purpose— Occult atrial fibrillation (AF) causes a relevant proportion of initially cryptogenic stroke (CS), but prolonged rhythm monitoring is difficult to apply to all such patients. We hypothesized that blood biomarkers indicating heart failure (NT-proBNP [N-terminal pro-brain natriuretic peptide]) and hypercoagulability (D-dimer, AT-III [antithrombin-III]) were associated with AF-related stroke and could serve to predict the likelihood of AF detection in CS patients early on. Methods— Over a 1-year period, we prospectively applied a defined etiologic work-up to all ischemic stroke patients admitted to our stroke unit. If no clear stroke cause was detected (CS), patients underwent extended in-hospital cardiac rhythm monitoring (≥72 hours). Blood to determine biomarker levels was drawn within 24 hours after admission. Results— Of 429 patients, 103 had AF-related stroke. Compared with noncardiac stroke patients (n=171), they had higher NT-proBNP (1867 versus 263 pg/ml) and D-dimer levels (1.1 versus 0.6 µg/ml), and lower AT-III concentration (89% versus 94%). NT-proBNP ≥505 pg/ml distinguished AF-related from noncardiac stroke with a sensitivity of 93% and a specificity of 72%. D-dimer and AT-III cutoffs had lower sensitivities (61% and 53%) and specificities (58% and 69%) for AF-related stroke. Of all initially 143 CS patients, 14 were diagnosed with AF during in-hospital monitoring. The preidentified NT-proBNP cutoff ≥505 pg/ml correctly predicted AF in 12 of them (86%, negative predictive value: 98%), while D-dimer and AT-III cutoffs were noncontributory. Conclusions— This study supports the association of NT-proBNP and to a lesser extent of hypercoagulation markers with AF-related stroke. NT-proBNP seems helpful in selecting CS patients for immediate extended cardiac rhythm monitoring to detect occult AF whereby levels <505 pg/ml seem to have a high-negative predictive value.

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