Abstract 14083: Implantable Loop Recorders Change Management in Patients With Cryptogenic Stroke With or Without Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Danni Fu ◽  
Richard Jones ◽  
Xing Dai ◽  
Michael Wu ◽  
Tina Burton
Keyword(s):  
Atrial Fibrillation ◽  
Rhode Island ◽  
Clinical Management ◽  
Cryptogenic Stroke ◽  
Cardiac Risk ◽  
Structural Features ◽  
Battery Life ◽  
Single Center Study ◽  
Implantable Loop Recorders

Introduction: Implantable loop recorders (ILR) are widely used for long term arrhythmia monitoring in patients with cryptogenic stroke (CS). Single center study has shown that some patients with incidental arrhythmias found by ILR, aside from atrial fibrillation (AF), resulted in changes in clinical management. Unfortunately, a large portion of the patients had premature ILR explantation before the end of battery life and other studies on incidental arrhythmias are limited. Hypothesis: We sought to determine the rate of occurrence of incidental arrhythmias other than AF on ILR monitoring among patients with CS and to characterize the rate of these incidental arrhythmias that result in a change in clinical management. Methods: All adult patients with ILR for CS at Rhode Island Hospital between 1/2015-1/2019 were included. Demographics, cardiac risk factors and structural features, and ILR tracings were reviewed. Results: Three hundred and twelve patients were identified with a median follow up time of 27.9 months (IQR 18.5-35.8 months). Incidental arrhythmias were identified in 110 patients (35.2%) with a median of 7.8 months (IQR 4.4-16.2 months) at a rate of 20.1 per 100 person-years. AF was detected in 51 patients (16.3%) with a median of 3.9 months (IQR 1.3-12.3 months). Eighteen patients had both AF and incidental arrhythmias and incidental arrhythmias were found after AF in 8 of those patients. Premature explantation occurred in 9.3% of patients with the most common reason being patient preference. Twelve patients with incidental arrhythmias (10.9%) had a resultant change in management; 9 with procedural interventions and 3 with medication adjustments. Overall, the rate of actionable incidental arrhythmias is 2.2 per 100 person-years. Conclusions: Other than AF detection, long term EKG monitoring in patients with CS with ILR allows for detection of other arrhythmias. These incidental findings can result in changes in management and potentially favorable clinical outcomes.

scholarly journals Radiofrequency versus Cryoballoon Ablation of Atrial Fibrillation: An Evaluation Using ECG, Holter Monitoring, and Implantable Loop Recorders to Monitor Absolute and Clinical Effectiveness

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Karapet Davtyan ◽  
Victoria Shatakhtsyan ◽  
Hermine Poghosyan ◽  
Alexandr Deev ◽  
Alexey Tarasov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Effectiveness ◽  
Holter Monitoring ◽  
Patient Characteristics ◽  
Cryoballoon Ablation ◽  
End Point ◽  
Radiofrequency Current ◽  
Implantable Loop Recorders

Introduction. While several studies have compared the radiofrequency current (RFC) and cryoablation for the treatment of patients with atrial fibrillation (AF), no study has monitored the long-term outcomes with the usage of implantable loop recorders (ILRs). Methods. We enrolled 89 consecutive patients with nonvalvular paroxysmal AF (N=44 for RFC and N=45 for cryoballoon). The primary efficacy end point was the assessment of effectiveness for each group (RFC versus cryoballoon) when examining freedom from arrhythmia by monitoring with ECG, Holter, and implantable loop recoder (ILR). The primary safety end point compared rates of adverse events between both groups. The secondary efficacy end point examined the duration of the postablation blanking period from ILR retrieved data. Results. The mean age of the study population was 56.6±10.2 years, and the follow-up duration was 12 months. There were no differences in baseline patient characteristics between groups. At 12 months, the absolute effectiveness (measured by ILR) was 65.9% in the RFC group and 51.1% in the cryoballoon group (OR = 1.85; 95% CI: 0.79–4.35; p=0.157), and the clinical effectiveness (measured by ECG and Holter) was 81.8% in the RFC group and 55.6% in the cryoballoon group (OR = 3.6; 95% CI: 1.37–9.46; p=0.008). There was no difference in safety between both groups. Asymptomatic episodes were significantly more present in the RFC group as measured by ILRs (p<0.010). In cryoballoon group, arrhythmia episodes were recorded equally irrespective of the follow-up method (i.e., ECG and Holter versus ILR (p>0.010)). The blanking period does not seem to be as important in cryoballoon as compared to RFC. Conclusion. RFC and cryoballoon ablation had similar absolute effectiveness at 12 months. ECG and Holter were effective when assessing the efficacy of the cryoballoon ablation; however, in the RFC group, ILR was necessary to accurately assess long-term efficacy.

scholarly journals Predictors of Occult Paroxysmal Atrial Fibrillation in Cryptogenic Strokes Detected by Long-Term Noninvasive Cardiac Monitoring

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Archit Bhatt ◽  
Arshad Majid ◽  
Anmar Razak ◽  
Mounzer Kassab ◽  
Syed Hussain ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Cardiac Monitoring ◽  
High Signal ◽  
Detection Rates ◽  
Non Invasive ◽  
Patient Reported ◽  
Premature Beats

Background and Purpose. Paroxysmal Atrial fibrillation/Flutter (PAF) detection rates in cryptogenic strokes have been variable. We sought to determine the percentage of patients with cryptogenic stroke who had PAF on prolonged non-invasive cardiac monitoring.Methods and Results. Sixty-two consecutive patients with stroke and TIA in a single center with a mean age of 61 (+/− 14) years were analyzed. PAF was detected in 15 (24%) patients. Only one patient reported symptoms of shortness of breath during the episode of PAF while on monitoring, and 71 (97%) of these 73 episodes were asymptomatic. A regression analysis revealed that the presence of PVCs (ventricular premature beats) lasting more than 2 minutes (OR 6.3, 95% CI, 1.11–18.92;P=.042) and strokes (high signal on Diffusion Weighted Imaging) (OR 4.3, 95% CI, 5–36.3;P=.041) predicted PAF. Patients with multiple DWI signals were more likely than solitary signals to have PAF (OR 11.1, 95% CI, 2.5–48.5,P<.01).Conclusion. Occult PAF is common in cryptogenic strokes, and is often asymptomatic. Our data suggests that up to one in five patients with suspected cryptogenic strokes and TIAs have PAF, especially if they have PVCs and multiple high DWI signals on MRI.

scholarly journals PREDICTORS OF ATRIAL FIBRILLATION DURING LONG-TERM ARRHYTHMIA MONITORING FOLLOWING CRYPTOGENIC STROKE

2020 ◽  
Vol 75 (11) ◽  
pp. 497
Author(s):  
Michael Riordan ◽  
Ayhan Yoruk ◽  
Arwa Younis ◽  
Adil Ali ◽  
Amanda Opaskar ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cryptogenic Stroke

scholarly journals P1066Predictors of atrial fibrillation detection in patients with implantable loop recorders for cryptogenic stroke

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii234-iii234
Author(s):  
B. Yeneneh ◽  
J. Munro ◽  
S. Wilansky ◽  
J. Behai ◽  
L. Scott
Keyword(s):  
Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Implantable Loop Recorders ◽  
Atrial Fibrillation Detection

scholarly journals Three year incidence and duration of atrial fibrillation episodes among a large, real-world population of cryptogenic stroke patients with insertable cardiac monitors

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P.D Ziegler ◽  
J.D Rogers ◽  
M Richards ◽  
A.J Nichols ◽  
S.W Ferreira ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Real World ◽  
Stroke Prevention ◽  
Detection Rate ◽  
Large Population ◽  
Cryptogenic Stroke ◽  
World Population ◽  
Median Frequency ◽  
Secondary Stroke Prevention

Abstract Background/Introduction The primary goal of monitoring for atrial fibrillation (AF) after cryptogenic stroke (CS) is secondary stroke prevention. Therefore, long-term monitoring of CS patients with insertable cardiac monitors (ICMs) is likely important to ensure appropriate secondary stroke prevention therapy, regardless of when AF is detected after the index event. However, long-term data on the incidence and duration of AF from real-world populations are sparse. Purpose To investigate the long-term incidence and duration of AF episodes in real-world clinical practice among a large population of patients with ICMs placed for AF detection following CS. Methods We included patients from a large device manufacturer's database who received an ICM for the purpose of AF detection following CS and were monitored for up to 3 years. All detected AF episodes (≥2 minutes) were adjudicated. We quantified the AF detection rate for various episode duration thresholds using Kaplan-Meier survival estimates, analyzed the maximum duration of AF episodes, and measured the time to initial AF detection. Results A total of 1247 patients (65.3±13.0 years, 53% male) were included and followed for 763±362 days. AF episodes (n=5456) were detected in 257 patients, resulting in a median frequency of 5 episodes [IQR 2–19] per patient. At 3 years, the AF detection rate for episodes ≥2 minutes was 24.2%. The AF detection rates at 3 years for episodes ≥6 minutes, ≥30 minutes, and ≥1 hour were 22.4%, 20.6%, and 19.1%, respectively. The median duration of the longest detected AF episode was 4.4 [IQR 1.2–13.9] hours and the median time to AF detection was 129 [IQR 45–354] days. Conclusion AF episodes were detected via ICMs in approximately one-quarter of CS patients within 3 years of follow-up. More than 75% of patients with AF detected had episodes lasting ≥1 hour and half had episodes lasting ≥4 hours. Detection of the first AF episode typically occurred beyond the range of conventional ambulatory monitors. Long-term surveillance of CS patients is likely important given the appreciable incidence, frequency, and duration of these AF episodes. Funding Acknowledgement Type of funding source: None

P1466Leadless pacemaker mid and long term follow-up in a single center-study

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
J L Martinez Sande ◽  
J Garcia-Seara ◽  
L Gonzalez-Melchor ◽  
C E Cacho-Antonio ◽  
X A Fernandez-Lopez ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pacemaker Implantation ◽  
Electrical Performance ◽  
Single Center ◽  
Electrical Parameters ◽  
Single Center Study ◽  
Long Term Follow Up ◽  
Center Study

Abstract Introduction and objectives Initial results of Leadless pacemakers (LPM) has been promising in worldwide, nevertheless there are still no long term experience published, so the objective of our study was to evaluate electrical parameters at mid  and long term follow-up, describing as well total complications and mortality in a single center-study. Methods   This was a prospective, observational clinical trial that included 183 consecutive patients, with an indication for a single-chamber pacemaker implantation. Results   All successful implantation included a total of 183 patients with a mean age of 79,2 ±6,6 years (range 54-93y/o); 111 (60,6%) were men and more frequent rhythm was permanent atrial fibrillation (160), including those in which a node ablation was performed in the same procedure (22). Clinical and echocardiographyc characteristics are described in table 1.Mean follow-up was of 26 ±10 months including: 64 patient at 24 months, 46 at 36 months and 7 patients at 48 months. Electrical parameters are represented in figure 1, which were stable and flawless at long term follow-up.  Total complications were 3,3%, with only 2 patient requiring surgery for resolution (1,7%), and all were acute during LPM implantation. A total of 17 patients (9,3%) died with no relation to pacemaker.  Conclusions In our experience, leadless pacemakers electrical performance continues stable, appropriate at long term follow-up, and no other complications developed. Baseline Characteristics of Patients Age(years) 79.2 ± 6.6[54-93] Male gender, n (%) 118 (60.6%) Hypertension, n (%) 149 (81.7%) Diabetes mellitus, n (%) 64 (34.9%) COPD, n (%) 33(18.3%) Renal dysfunction, n (%) 30 (16.7%) Valvular disease, n (%) 74 (41.1%) Atrial Fibrillation, n (%) 161 (98.0%) LVEF(%) 60.0 ± 8 OAC, n (%) 123(67.2%) NOAC, n (%) 23 (10.0%) Abstract Figure. Electrical performance

Abstract 17109: Real World Assessment of Atrial Fibrillation and Other Arrhythmias After Cryptogenic Stroke

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Naga Venkata K Pothineni ◽  
Uyanga Batnyam ◽  
Jeffrey Arkles ◽  
John Bullinga ◽  
Brett L CUCCHIARA ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trials ◽  
Real World ◽  
Cryptogenic Stroke ◽  
Premature Ventricular Contractions ◽  
Entire Cohort ◽  
Detection Algorithms ◽  
Term Monitoring

Introduction: Long-term monitoring for atrial fibrillation (AF) is recommended in patients, who have experienced a cryptogenic stroke (CS). Clinical trials have identified AF in ~30% of patients after 3 years of continuous monitoring with insertable cardiac monitors (ICMs). Hypothesis: In a real-world analysis from a large academic healthcare system, we sought to evaluate a CS population with ICMs and a) determine the yield of AF and subsequent initiation of anticoagulation; and b) identify the presence of other arrhythmias. Methods: We evaluated all CS patients who had received an ICM between October 2014 and April 2020. We manually reviewed all stored electrocardiograms that were automatically labeled as AF by the ICM and adjudicated them as either a) AF or b) other cardiac arrhythmia including premature atrial contractions (PAC), premature ventricular contractions (PVC), supraventricular tachycardia (SVT), or nonsustained ventricular tachycardia (NSVT). Results: A total of 84 CS patients with ICMs were included: 51% men, mean age 63 years, and mean CHA 2 DS 2 -VASc 4.1. Over a median follow-up duration of 15.7 months, there were 34 patients (40% of the cohort) who did not have any AF alerts. In the remaining 50 patients, there were 960 stored electrograms that were adjudicated. Only 154 recordings from 16 patients (19% of the entire cohort) were adjudicated as AF. Oral anticoagulation was initiated in all these patients with adjudicated AF. The remaining tracings, which had been automatically categorized by the ICM as AF alerts, represented 34 patients (40% of the cohort). These patients had other arrhythmias including frequent PACs or PVCs, SVT, or NSVT. Conclusions: Compared to clinical trials, our real-world assessment suggests that the yield of AF following CS is lower - approximately 20%. Our findings highlight the importance for reviewing device tracings given the high rates of false positive for AF. Further research to refine AF detection algorithms in ICMs is needed.

Abstract 13293: Detection of Atrial Fibrillation by Implantable Loop Recorders Following Cryptogenic Stroke: A Retrospective Study of Predictive Factors and Outcomes

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sara Samaan ◽  
Beshoy Nazeer ◽  
Heidi Stoute ◽  
Wei Zhao ◽  
Susanna Szpunar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Stroke Prevention ◽  
Multivariable Analysis ◽  
Cryptogenic Stroke ◽  
Embolic Stroke ◽  
Stroke Recurrence ◽  
Secondary Stroke Prevention ◽  
Recurrence Rates ◽  
Implantable Loop Recorders

Introduction: Cryptogenic strokes account for up to 40% of ischemic strokes. Atrial fibrillation (AF) is a known cause of ischemic stroke. Current data shows that occult AF can be detected by implantable devices at higher rates than conventional cardiac rhythm monitoring. There are, however, limited data available on risk factors and outcomes associated with AF detection by implantable loop recorders (ILRs). Objective: To investigate the risk factors and outcomes associated with occult AF detected by ILR in patients with cryptogenic stroke. Methods: We conducted a retrospective chart review of patients admitted with cryptogenic stroke at Ascension St John Hospital and Ascension Macomb-Oakland Hospital in Michigan who had ILRs placed from 1/1/2016 to 1/31/2020. Data were collected on demographics, comorbidities, treatment and outcomes. AF detection was defined as continuous AF for 30 seconds. Data were analyzed using Student’s t-test, the χ2 test and logistic regression. Results: We reviewed 172 patients, 52.3% male, 56.4% white, mean age 62.7 ± 13.6 years. The incidence of AF detection by ILR was 14% (24/172) over a mean follow-up of 12.75 ± 10.71 months. The mean duration of monitoring prior to AF detection was 4.5 months (range:1 day to 14 months). The median duration of AF was 6 minutes (range: 37.2 seconds to 11.3 hours). From univariable analysis, older age (p=0.03), male sex (p=0.09), embolic stroke pattern on imaging (p=0.06), and lack of AF symptoms (p=0.001) were associated with AF detection by ILR. From multivariable analysis, patients with detected AF were more likely to be older (OR=1.04, p=0.04), male (OR=3.6, p=0.03), asymptomatic (OR=6.3, p=0.01), and have an embolic stroke pattern on imaging (OR=3.3, p=0.04). 95.7% of patients with confirmed AF were started on anticoagulation for secondary stroke prevention. There was no difference in the incidence of stroke post-hospitalization between those with AF detection and those without (16% vs. 16.4%, p=0.96). Conclusions: In patients with cryptogenic stroke, age, gender, stroke pattern, and lack of AF symptoms are independent predictors of occult AF detection by ILR. Most patients with confirmed AF were started on anticoagulation for secondary stroke prevention and had low stroke recurrence rates.

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