scholarly journals Implantable cardiac monitor after cryptogenic stroke: atrial fibrillation detection and predictors

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Ebrille ◽  
C Amellone ◽  
M.T Lucciola ◽  
F Orlando ◽  
M Suppo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Risk Stratification ◽  
Median Time ◽  
Remote Monitoring ◽  
Cryptogenic Stroke ◽  
Screening Process ◽  
Cardiac Monitor ◽  
Implantable Cardiac Monitor

Abstract Objective The main objective of our study was to analyze the incidence and predictors of atrial fibrillation (AF) in patients with cryptogenic stroke (CS) who received an implantable cardiac monitor (ICM) at our Institution. Methods From November 2013 to October 2017, a total of 133 patients who had suffered a CS were implanted with an ICM after a thorough screening process. The median time between the thromboembolic event and ICM implantation was 64 days [IQ range: 16–111]. All implanted patients were followed with remote monitoring until the first detected episode of AF or up to December 2018. Every remote monitoring transmission and related electrograms were analyzed by the dedicated Electrophysiology Nursing team and confirmed by experienced Electrophysiologists. AF was defined by any episode lasting greater than or equal to 2 minutes. Results During a median follow-up of 14.8 months [IQ range: 3.0–31.2], AF was detected in 65 out of 133 patients (48.9%). The median time from ICM implantation and AF detection was 3.5 months [IQ range: 0.9–6.7]. The prevalence of AF was 22.6%, 34.4%, 40.8% and 48.3% at 3, 6, 12 and 24 months respectively. At the multivariate analysis, high premature atrial contractions (PAC) burden and left atrium (LA) dilation were the only independent predictors of AF detection (HR 2.82, 95% CI 1.64–4.83, p<0.001 for PAC; HR 1.75, 95% CI 1.03–2.97, p=0.038 for LA dimension). Patients were dived into categories based on the probability of AF detection (low, intermediate and high risk) and a new risk stratification algorithm was implemented (Figure 1). Conclusion After a thorough screening process, AF detection in patients with CS and ILM was quite high. Having a high PAC burden and LA dilation predicted AF episodes at the multivariate analysis. A new risk stratification algorithm was developed. Figure 1 Funding Acknowledgement Type of funding source: None

Abstract W P194: Improved Efficacy of ICM Detection of Atrial Fibrillation in Cryptogenic Stroke Patients with MRI-Defined Infarcts: Preliminary Results from the SPIDER Registry

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Kelley Joseph ◽  
Stephen Wanjiku ◽  
Mohammed Jumaa ◽  
Mark Richards
Keyword(s):  
Atrial Fibrillation ◽  
Detection Rate ◽  
Brain Mri ◽  
Cryptogenic Stroke ◽  
Mri Imaging ◽  
Cardiac Monitor ◽  
The Brain ◽  
Improve Access ◽  
Implantable Cardiac Monitor

Introduction: Recent trials have demonstrated the efficacy of the implantable cardiac monitor (ICM) in detecting atrial fibrillation (AF) in cryptogenic stroke (CS) patients. However, these trials have included patients with TIAs or no CT or MRI imaging of the brain. We hypothesized that the AF detection rate in CS patients would be improved by requiring the presence of an embolic-appearing infarct on MRI. Methods: All CS patients within the Promedica Stroke Network were considered for inclusion in the SPIDER (Stroke Prevention through the Improved Detection of AF) registry. All patients were monitored by inpatient telemetry for AF for a minimum of 48 hours, and received brain MRI with or without angiography. Patients with no AF, a negative transesophageal echo for ASD/PFO, and an embolic-appearing MRI infarct (wedge infarct, multiple vascular distributions) were offered an ICM (Reveal or Reveal LINQ™) for AF detection (minimum of 10 seconds). Results: 64 patients have been enrolled to date and followed for 223 days. Mean age was 66.9 ± 12.8 years and 40.6% were female with a median NIH stroke score of 5.2 on presentation. AF episodes were detected in 11 patients, resulting in an AF detection rate of 17.2% and a median time to AF detection of 35 days. While both mean follow-up and time to AF detection were comparable to the data from CRYSTAL-AF (6 months, 41 days), AF detection rate was increased nearly two-fold. Conclusions: Here we show that restricting ICM implantation for AF detection in CS patients to those with MRI-defined embolic-appearing infarcts improves efficacy, with an increase of 8.3% in detection at six months, when adjusted for follow-up time. Explanations for this higher detection rate might include a slightly higher age (66.9 vs 61.5 years of age), a more liberal cutoff for AF (10 vs 30 seconds), and, likely, a more highly selected patient population. Such an approach might both improve access to this important technology and help preserve health care resources.

scholarly journals 287TIME TO INITIAL DETECTION OF ATRIAL FIBRILLATION [AF] WITH IMPLANTABLE CARDIAC MONITOR [ICM] IN CRYPTOGENIC STROKE

2016 ◽  
Vol 45 (suppl 2) ◽  
pp. ii1.50-ii12
Author(s):  
Nkechi Uzomefuna ◽  
Frederick Okpoko ◽  
Hafiz Hussein ◽  
David Williams ◽  
Brendan McAdam
Keyword(s):  
Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Cardiac Monitor ◽  
Implantable Cardiac Monitor

P1011Cryptogenic stoke and asymptomatic atrial fibrillation in a real world population: a single centre, implantable loop recorder study

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Faustino ◽  
V Di Stefano ◽  
R Franciotti ◽  
N Furia ◽  
E Di Girolamo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Real World ◽  
Cryptogenic Stroke ◽  
Daily Practice ◽  
World Population ◽  
Real World Data ◽  
Loop Recorder ◽  
Cardiac Monitor ◽  
Mean Time

Abstract Funding Acknowledgements None Background The incidence of atrial fibrillation (AF) in cryptogenic stroke (CS) patients has been studied in carefully controlled clinical trials, but real-world data are limited. Purpose Aim of this study was to investigated the incidence of AF in clinical practice among CS patients with an implantable cardiac monitor (ICM) recommended (IIA) for AF detection. Methods Patients with CS admitted to our Stroke Unit were included in the study. Patiens received an ICM and were monitored for up to 2 years for AF detection (in-hospital clinic and remote monitoring). All detected AF episodes (≥30 sec) were considered. Results From March 2016 to March 2019, 58 patients (mean age 68 ±12 years, 67% male) received an ICM to detect AF after a CS.  No patients were lost during follow-up. AF was detected in 23 patients (40% overall; AF group mean age 72 ± 11 years; 65% male) after a mean time of 6 months from ICM implantation (ranging from 2 days up to 2 years) and 8 months after CS (ranging from 1 month up to 2 years). In these AF patients anticoagulant treatment was prescribed, and no further stroke was reported. Conclusions AF episodes were detected via continuous monitoring with ICMs in 40% of implanted CS patients. AF after CS was asymptomatic and thus unlikely to be detected by strategies based on intermittent short-term recordings. Therefore, ICMs should be considered as part of daily practice in the evaluation of CS patients. Abstract Figure 1. Detection rate over time

P5648Efficiency and accuracy of arrhythmia detection using implantable cardiac monitor: A prospective multicenter randomized clinical trial comparing Reveal LINQ and Confirm Rx

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Yokokawa ◽  
B Jaffe ◽  
R Ip ◽  
R Azad ◽  
M Castellani ◽  
...  
Keyword(s):  
Heart Rate ◽  
Data Transmission ◽  
Cardiac Arrhythmias ◽  
Randomized Study ◽  
Cryptogenic Stroke ◽  
Data Availability ◽  
P Wave ◽  
Cardiac Monitor ◽  
Implantable Cardiac Monitor

Abstract Background Implantable cardiac monitor (ICM) has been used to detect occult cardiac arrhythmias in a variety of clinical situations. The reliability and accuracy of diagnosing cardiac arrhythmia could impact patient care. However, it is not clear the efficiency and reliability of detecting cardiac arrhythmias between currently available two ICMs. Purpose To compare the efficiency and accuracy of diagnosing cardiac arrhythmias between Reveal LINQ™ and Confirm Rx™. Methods In the prospective multicenter randomized study, a total of 80 patients (age: 61±17 years, men: 41 [51%]) with cryptogenic stroke (n=52) or recurrent unexplained episodes of palpitations (n=3) or syncope (n=25) received an ICM for detection of arrhythmias. Patients were randomized one to one into receiving either Reveal LINQ™ or Confirm Rx™. Arrhythmic events are defined as pauses of ≥3.0 seconds, bradycardia with heart rate of ≤40 bpm, tachycardia with heart rate of ≥150 bpm, and atrial fibrillation (AF). The time of detected arrhythmic events and patient activated events to the time of data availability on respective website site for analysis were compared between the two ICM. All of the arrhythmia events were adjudicated by two cardiologists to assess the accuracy. Results A total of 680 arrhythmic events including 352 AFs, 109 bradycardias, 167 tachycardias and 52 pauses were transmitted over a mean follow-up of 4.2±2.5 months. The mean time to data transmission was significantly faster in Confirm Rx™ than in Reveal LINQ™ (24±103 vs 475±426 min, P<0.0001). One-hundred fifty-nine of 352 AF events (45%) and 237 of 328 non-AF events (72%) were accurately detected by ICMs (P<0.0001). Twenty-eight of 51 AF events (55%) were detected accurately by Reveal LINQ™ and 131 of 301 AF events (44%) were accurately detected by Confirm Rx™ (P=0.13). The reason for inaccurate AF detection was frequent ectopic beats (n=134), P-wave oversensing (n=15), T-wave oversensing (n=8), both P- and T-waves oversensing (n=18) and sinus tachycardia with R-wave undersensing (n=18). Conclusions Data transmission of arrhythmic events using Confirm Rx™ is significantly faster than Reveal LINQ™. The accuracy of AF detection with current algorithms in both ICM remains suboptimal. More patients and longer follow-up is required to confirm these findings.

scholarly journals Atrial fibrillation burden, episode duration and frequency in relation to quality of life in patients with implantable cardiac monitor

2021 ◽  
Vol 34 ◽  
pp. 100791
Author(s):  
Victoria Jansson ◽  
Lennart Bergfeldt ◽  
Jonas Schwieler ◽  
Göran Kennebäck ◽  
Aigars Rubulis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Cardiac Monitor ◽  
Episode Duration ◽  
Atrial Fibrillation Burden ◽  
Implantable Cardiac Monitor

IRMA study: Prevalence of subdiaphragmatic visceral infarction in ischemic stroke and atrial fibrillation

2016 ◽  
Vol 12 (4) ◽  
pp. 421-424 ◽  
Author(s):  
David Weisenburger-Lile ◽  
Delphine Lopez ◽  
Stephanie Russel ◽  
Jean-Emmanuel Kahn ◽  
Ana Veiga Hellmann ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
High Risk ◽  
Median Time ◽  
Cryptogenic Stroke ◽  
Abdominal Mri ◽  
Frequent Localization

Background Occult atrial fibrillation (AF) may, in part, explain cryptogenic stroke. A 22% prevalence of subdiaphragmatic visceral infarction (SDVI) among patients with ischemic stroke (IS) due to AF has been reported, using abdominal MRI. We sought to assess the reproducibility of this method and to confirm that SDVI is more prevalent in cases of AF-caused IS than in IS of other etiologies. Methods In consecutive patients admitted to our hospital, we compared SDVI prevalence in three groups: patients with IS due to AF (IS+/AF+ group), patients with stroke of another determined cause (IS+/AF− group) and patients with AF without stroke (IS−/AF+ group). Results A total of 111 patients were included. The median time between inclusion and abdominal MRI was six days. SDVI was more frequent in the IS+/AF+ group ( n = 10; 21.3%), than in IS+/AF− ( n = 1; 3.3%) and IS−/AF+ ( n = 0) groups, p = 0.002. The most frequent localization was the kidney. Conclusions The prevalence of SDVI was higher among patients with AF-caused IS. In cases of cryptogenic stroke, a positive abdominal MRI may suggest occult AF as the cause and identify a high risk of AF in this subgroup of patients.

Abstract 13915: Atrial Fibrillation Begets Atrial Fibrillation in Cryptogenic Stroke Patients: Results from the Crystal-AF Trial

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Rod S Passman ◽  
Jodi L Koehler ◽  
Paul D Ziegler
Keyword(s):  
Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Secondary Stroke Prevention ◽  
Stroke Patients ◽  
Cardiac Monitor ◽  
Long Duration ◽  
Episode Duration ◽  
Duration Information ◽  
The Impact ◽  
Insertable Cardiac Monitor

Introduction: Initial episodes of atrial fibrillation (AF) detected following a cryptogenic stroke (CS) may be brief in duration and the clinical relevance of such episodes is uncertain. Hypothesis: We investigated whether an initial brief episode of AF was predictive of subsequent long duration AF episodes in CS patients (pts) with an insertable cardiac monitor (ICM). Methods: CS pts (n=208, age 61.6±11.3 years, 66% male) randomized to the ICM arm of the CRYSTAL-AF study and inserted with a device (Reveal® XT) were followed for 21±9 months. AF episodes (>30 seconds) were independently adjudicated and the first adjudicated AF episode was classified as brief (<1 hour) or long (≥1 hour). The incidence of subsequent long duration AF episodes among pts with an initially brief episode was computed. The impact of episode duration on prescription of oral anticoagulation (OAC) therapy was also assessed. Results: Among 36 pts with an adjudicated AF episode for which duration information was available, the initial episode was classified as brief in 18 (50%) pts and long in 18 (50%) pts. Among those with initially brief episodes, 10 (56%) experienced only subsequent brief episodes while 8 (44%) went on to experience at least one long AF episode. The median time between the initial brief episode and first long AF episode was 75 days [interquartile range: 27-624 days]. OAC was prescribed in 7/10 pts (70%) with only brief AF episodes compared to 26/26 pts (100%) with at least one long episode of AF (p=0.017). Conclusion: Initial AF episodes in pts with CS are equally likely to be of short or long duration. However, nearly half of CS pts with initially brief episodes of AF subsequently have long duration episodes detected much later via prolonged monitoring with ICMs. Therefore, early detection of brief AF episodes may merit more rigorous monitoring of AF with ICMs since physicians were significantly more likely to prescribe OAC for secondary stroke prevention in response to longer duration episodes.

Frequent Premature Atrial Contractions in Cryptogenic Stroke Predict Atrial Fibrillation Detection with Insertable Cardiac Monitoring

2020 ◽  
Vol 49 (2) ◽  
pp. 144-150 ◽  
Author(s):  
Kenichi Todo ◽  
Tomonori Iwata ◽  
Ryosuke Doijiri ◽  
Hiroshi Yamagami ◽  
Masafumi Morimoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Frequency ◽  
Strong Predictor ◽  
Cryptogenic Stroke ◽  
High Plasma ◽  
Cardiac Monitoring ◽  
Stroke Patients ◽  
Chads2 Score ◽  
Index Stroke

Objective: To determine whether frequent premature atrial contractions (PAC) predict atrial fibrillation (AF) in cryptogenic stroke patients, we analyzed the association between frequent PACs in 24-h Holter electrocardiogram recording and AF detected by insertable cardiac monitoring (ICM). Methods: We retrospectively analyzed a database of 66 consecutive patients with cryptogenic stroke who received ICM implantation between October 2016 and March 2018 at 5 stroke centers. We included the follow-up data until June 2018 in this analysis. We defined frequent PACs as the upper quartile of the 66 patients. We analyzed the association of frequent PACs with AF detected by ICM. Results: Frequent PACs were defined as >222 PACs per a 24-h period. The proportion of patients with newly detected AF by ICM was higher in patients with frequent PACs than those without (50% [8/16] vs. 22% [11/50], p < 0.05). Frequent PACs were associated with AF detection and time to the first AF after adjustment for CHADS2 score after index stroke, high plasma ­B-type natriuretic peptide (BNP; >100 pg/mL) or serum ­N-terminal pro-BNP levels (>300 pg/mL), and large left atrial diameter (≥45 mm). Conclusion: High frequency of PACs in cryptogenic stroke may be a strong predictor of AF detected by ICM.

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