scholarly journals How to Manage Occult Atrial Fibrillation Detected on Long-Term Monitoring

Circulation ◽  
2016 ◽  
Vol 133 (13) ◽  
pp. 1290-1295 ◽  
Author(s):  
Gregory Y.H. Lip
Keyword(s):  
Atrial Fibrillation ◽  
Long Term Monitoring ◽  
Term Monitoring

First clinical experience with the wearable cardiac rhythm long-term monitoring cardioskin device

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Guedeney ◽  
J Silvain ◽  
F Hidden-Lucet ◽  
C Maupain ◽  
S Dinanian ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Cardiac Rhythm ◽  
Cardiac Monitoring ◽  
Funding Source ◽  
Single Center ◽  
Long Term Monitoring ◽  
Monitoring Devices ◽  
Term Monitoring

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

scholarly journals Supraventricular Runs in 7-Day Holter Monitoring Are Related to Increased Incidence of Atrial Fibrillation in a 3-Year Follow-Up of Cryptogenic Stroke Patients Free from Arrhythmia in a 24 h-Holter

2021 ◽  
Vol 8 (7) ◽  
pp. 81
Author(s):  
Andrzej Kułach ◽  
Milena Dewerenda ◽  
Michał Majewski ◽  
Anetta Lasek-Bal ◽  
Zbigniew Gąsior
Keyword(s):  
Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Holter Monitoring ◽  
Ecg Monitoring ◽  
Stroke Patients ◽  
Long Term Monitoring ◽  
In Cis ◽  
Term Monitoring

Introduction: Silent atrial fibrillation (AF) is a common cause of cryptogenic ischemic stroke (CIS). The 24-h-Holter is insufficient to reveal an occult arrhythmic cause of stroke and the strategy to select the patients for long-term monitoring is missing. Objectives: The aim of the study was to evaluate 7-day-Holter monitoring to identify cases with the arrhythmic cause of stroke in CIS patients in whom 24-h-Holter was free from arrhythmia, and to assess the relation between supraventricular (SV) runs in baseline Holter and the incidence of AF in a 3-year follow-up period. Methods: 78 patients (aged 60 ± 9 years, 45 males) with CIS and no arrhythmic findings in 24-h-Holter were enrolled. All patients had 7-day-Holter monitoring after stroke and were followed up for 36 months, and then 7-day Holter was repeated. We assessed SV runs (≥5 QRS) in the initial 7-day Holter and analyzed the relation of the findings with clinical characteristics of novel AF episodes revealed early after stroke and during a 3-year follow-up. Results: Baseline 7-day-Holter revealed SV runs in 36% of patients and AF in 9% of cases. During a 3-year follow-up, 8 additional cases were confirmed, both in standard care and in repeated Holter (a total of 19% of AF cases). There was no difference with regard to CHADS2VASc score (3.6 ± 1.1 vs. 3.4 ± 1.5; p = NS) and left atrium parameters between patients with SV runs and the non-arrhythmic group. Patients with SV runs had a higher incidence of AF both after stroke and in a 3-year follow-up (46% vs. 4%, RR 11.6, p < 0.001). In 8 cases, patent foramen ovale was detected during follow-up. Conclusions: A strategy of baseline 7-day-Holter monitoring after stroke allows for disclosing SV runs in every third case and AF in 9% of stroke survivors. Patients with SV runs have a higher incidence of AF (RR 11.6, p < 0.001) and should be considered for extended continuous ECG monitoring.

scholarly journals The culprit of cryptogenic stroke: the short-term versus long-term atrial fibrillation detection rate in a tertiary care centre

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
F Wouters ◽  
P Vandervoort ◽  
D Mesotten ◽  
D Verhaert ◽  
J Vranken ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Unit ◽  
Detection Rate ◽  
Cryptogenic Stroke ◽  
Smartphone Application ◽  
Short Term ◽  
Long Term Monitoring ◽  
One Year ◽  
Term Monitoring

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Limburg Clinical Research Center OnBehalf Mobile Health Unit & Future Health Background Cryptogenic stroke (CS) and transient ischemic attack (TIA) patients have no determined aetiology at discharge. A possible cause for stroke is atrial fibrillation (AF). AF occurs in 20%-40% of the CS patients and diagnosis is highly dependent on monitoring duration. A long-term monitoring method is the insertable loop recorder (ILR), recommended by the European Society of Cardiology. However, this is not routinely used in Belgium despite reimbursement. Purpose This study aims to determine the AF detection rates of different methods used in clinical practice, ranging from short-term monitoring (monitoring in a stroke unit, 12-lead electrocardiogram (ECG), and 24-hour ECG), seven-day Holter, and long-term monitoring (smartphone application and ILR). Methods A monocentric, retrospective study was conducted in adults with CS or TIA between 1/01/17 - 1/01/20. Data were collected from the electronic medical record. The primary endpoint was the detection rate and time until first AF detection. Results A total of 368 patients suffered from a CS or TIA. Most of them were monitored in the stroke unit (96%) or with a 12-lead ECG (93%). A 24-hour ECG was used in 26%, a seven-day Holter in 38%. For long-term monitoring, a smartphone application was used in 3%. ILRs were inserted in 6%, with a median time of 102 days after stroke (IQR: 48-321). One year after ILR insertion, AF was detected in 23%. AF detection increased with monitoring duration, as shown in the figure, except for 24-hour ECG, which detected no AF. Therefore, the AF detection rate was different between short-term monitoring (5%)  and seven-day Holter (10%; p=.034), and short- and long-term monitoring (16%; p=.01). The age of CS patients without AF (Mdn = 71yr) was lower than those with AF (Mdn = 79yr; p=.001). The National Institutes of Health Stroke Scale (NIHSS) and the CHA2DS2-VASc score of patients without AF (Mdn = 3) was lower than those with AF (Mdn = 6, p&lt;.001; Mdn = 4, p=.004 respectively). The one-year mortality of patients with AF was 15% compared to 8% for patients without AF. No patients with an ILR deceased within one year after the stroke. Conclusions Detection of AF was associated with higher age, NIHSS, and CHA2DS2-VASc scores. These variables can be used to select patients for the insertion of ILRs. The detection rate of AF was significantly higher with long-term monitoring and seven-day Holter compared to short-term monitoring. However, only 38% of the patients were monitored for a week, and only 6% had an ILR inserted. Therefore, despite guideline recommendations, long-term cardiac monitoring is underutilised in this population of CS patients. Nevertheless, AF was still detected in 14% of CS patients within one year after the stroke. These findings emphasise the need for more monitoring with a seven-day Holter, smartphone app, and ILR in this patient population. Consequently, this will result in more accurate treatment of AF as secondary prevention of CS. Abstract Figure. Time to first AF detection after stroke

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