Abstract 1122‐000226: Collaborative Stroke Pathway for In‐Patient Implantation of Long‐Term Cardiac Rhythm Monitors for Atrial Fibrillation Detection

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Priyadarshee Patel ◽  
Alfredo Munoz ◽  
Elan Miller ◽  
Shaista Alam ◽  
Robin Dharia ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Collaborative Care ◽  
Cardiac Rhythm ◽  
Care Pathway ◽  
Cryptogenic Stroke ◽  
Stroke Recurrence ◽  
Large Artery ◽  
Lost To Follow Up

Introduction : Atrial fibrillation (AF) is a recognized risk factor of ischemic stroke and AF‐related stroke is twice more likely to prove fatal. Long‐term cardiac rhythm monitoring has greater diagnostic yield compared to conventional monitoring in detecting AF. Utility of implantable loop recorder (ILR) in detecting AF was established not only in patients with cryptogenic stroke but more recently in strokes due large artery atherosclerosis and small vessel disease Stroke AF trial. We present a collaborative care pathway and share multi‐year data on ILR implantation. Methods : A review of prospectively collected registry of ILR implantations performed at a Comprehensive stroke center was conducted. Data from 2017–2019 of in‐patient and out‐patient implantation was analyzed. Eligible patients identified by vascular neurology (VN) underwent in‐patient implantation primarily by interventional neurology (IN) and as out‐patient by electrophysiology Cardiology. In‐patient implant and programming were done on the day of discharge. Continuous monitoring was followed by EP Cardiology. AF detection was urgently communicated by EP Cardiology and anticoagulation initiated by VN. Patients lost to follow up or lacking information in medical records were excluded from analysis. Results : Total of 428 ILR implantations were performed over a period of 3 years (1/2017 ‐ 12/2019) with majority implants as in‐patient prior to discharge 290 (67.8%) and out‐patient 78 (32.2%). Inpatient ILR placement was noted to be 75% in 2017, 78% in 2018 and 80% in 2019. 57.2% of in‐patient ILRs were placed by IN and 42.8% by EP. Average time to in‐patient ILR was 4.1 days with 77% within 5, 18.5% within 10, and <5% within 11 or more days post‐stroke. Average time to out‐patient ILR placement was 57 days with only 16% within 15, 29% within 30 day and 53% in more than 30 days from stroke. Over the course of 2 years of monitoring, AFib was detected in 33% with false detection in 1.5% (19.6% in 2017, 26% in 2018 and 36.5% in 2019). Conclusions : A multispecialty collaborative care pathway to increase implantation rate in eligible patients is recommended. In‐patient implantation allows establishing continuity of care, patient retention, prevents lost to follow‐up, avoids delay in monitoring, and importantly decreases the risk of stroke recurrence by early initiation of anticoagulation.

scholarly journals Long-Term Follow-Up of Cardiac Rhythm in 320 Patients After the Cox-Maze III Procedure for Atrial Fibrillation

2016 ◽  
Vol 101 (4) ◽  
pp. 1443-1449 ◽  
Author(s):  
Anders Albåge ◽  
Birgitta Johansson ◽  
Göran Kennebäck ◽  
Göran Källner ◽  
Henrik Scherstén ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Rhythm ◽  
Long Term Follow Up

P6557Permanent atrial fibrillation development in patients with DDD pacemaker -Rrisk factors and association with mortality in long-term

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Debski ◽  
M Ulman ◽  
A Zabek ◽  
K Boczar ◽  
K Haberka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Hospital Discharge ◽  
Pacemaker Implantation ◽  
Cox Proportional Hazards Model ◽  
Registration System ◽  
All Cause Mortality ◽  
Lost To Follow Up

Abstract Background In patients undergoing permanent DDD cardiac pacing, the maintenance of atrial contractility is important to ensure adequate ventricular filling and to guarantee an optimal ventricular ejection capacity. Atrial fibrillation (AF) is a major risk factor for thromboembolic events and is associated with increased cardiovascular and all-cause mortality. Purpose To analyse the risk factors for development of permanent AF in patients with DDD pacemaker and determine its association with all-cause mortality in long-term follow-up. Methods Retrospectively collected records comprised all consecutive patients who underwent primary DDD pacemaker implantation at single-centre between 1984–2014. Patients who were lost to follow-up after hospital discharge were excluded from analysis. Follow-up was completed on 31st August 2016. Definition of permanent AF was the occurence of AF which persisted until the end of follow-up. Data on patients' survival status and deceased patients' dates of death were collected from the national death registration system. Information of death date was available as of 31st August 2016. The endpoint was all-cause mortality. Results We included a total of 3771 patients and 24,432 patient-years of follow-up and exluded 157 (4%) patients who were lost to follow-up after hospital discharge. Mean follow-up was 78±62 months (max. 370 months), 1761 (47%) were female. Paroxysmal AF prior to DDD pacemaker implantation was detected in 1276 patients (34%). During entire follow-up 717 (19%) patients developed permanent AF in a mean period of 55±50 months. Analysis of risk factors for development of permanent AF is presented in Figure. Cox proportional hazards model with time-dependent covariate showed that development of permanent AF significantly increased mortality during follow-up (HR = 1.885, 95% CI, 1.654–2.148, P<0.001; with adjustment for age at implantation and sex: HR = 1.475, 95% CI, 1.294–1.682, P<0.001). Permanent AF risk factors Conclusions Female sex protected against permanent AF development, whereas age at implantation, history of paroxysmal AF and apical position of RV lead increased the risk. Permanent AF was significantly increasing the all-cause mortality, even after adjustment for age at implant and gender. Acknowledgement/Funding None

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.

Relation of outcomes to ABC (Atrial Fibrillation Better Care) pathway adherent care in European patients with atrial fibrillation: an analysis from the ESC-EHRA EORP Atrial Fibrillation General Long-Term (AFGen LT) Registry

EP Europace ◽  
2020 ◽  
Author(s):  
Marco Proietti ◽  
Gregory Y H Lip ◽  
Cécile Laroche ◽  
Laurent Fauchier ◽  
Francisco Marin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Integrated Care ◽  
Lower Risk ◽  
Care Pathway ◽  
Real Life ◽  
Research Programme ◽  
Coronary Syndrome ◽  
The Impact

Abstract Aims There has been an increasing focus on integrated, multidisciplinary, and holistic care in the treatment of atrial fibrillation (AF). The ‘Atrial Fibrillation Better Care’ (ABC) pathway has been proposed to streamline integrated care in AF. We evaluated the impact on outcomes of an ABC adherent management in a contemporary real-life European-wide AF cohort. Methods and results Patients enrolled in the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry with baseline data to evaluate ABC criteria and available follow-up data were considered for this analysis. Among the original 11 096 AF patients enrolled, 6646 (59.9%) were included in this analysis, of which 1996 (30.0%) managed as ABC adherent. Patients adherent to ABC care had lower CHA2DS2-VASc and HAS-BLED scores (mean ± SD, 2.68 ± 1.57 vs. 3.07 ± 1.90 and 1.26 ± 0.93 vs. 1.58 ± 1.12, respectively; P &lt; 0.001). At 1-year follow-up, patients managed adherent to ABC pathway compared to non-adherent ones had a lower rate of any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death (3.8% vs. 7.6%), CV death (1.9% vs. 4.8%), and all-cause death (3.0% vs. 6.4%) (all P &lt; 0.0001). On Cox multivariable regression analysis, ABC adherent care showed an association with a lower risk of any TE/ACS/CV death [hazard ratio (HR): 0.59, 95% confidence interval (CI): 0.44–0.79], CV death (HR: 0.52, 95% CI: 0.35–0.78), and all-cause death (HR: 0.57, 95% CI: 0.43–0.78). Conclusion In a large contemporary cohort of European AF patients, a clinical management adherent to ABC pathway for integrated care is associated with a significant lower risk for cardiovascular events, CV death, and all-cause death.

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 Pure Thalamic Infarct: 8-Year Follow-Up Study in a Hospital in China

2021 ◽  
Vol 12 ◽  
Author(s):  
He Liang ◽  
Anand Karthik Sarma ◽  
Zhenxing Wang ◽  
Ming Mo ◽  
Jianwen Lin ◽  
...  
Keyword(s):  
Recurrent Stroke ◽  
Smoking History ◽  
Stroke Recurrence ◽  
Large Artery ◽  
Stroke Treatment ◽  
Toast Classification ◽  
Thalamic Infarct ◽  
Thalamic Infarcts

Pure thalamic infarct is a rare lacunar stroke type, with little known about long-term outcomes. This 8-year, single-center, retrospective study evaluated the clinical background, etiology, Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification, and 8-year follow-up results in 27 patients with pure thalamic infarcts identified by MR diffusion-weighted imaging in Dalian, China. All patients presented chief complaints of limb weakness or sensory disturbances. Hypertension (24/27, 88.9%), diabetes (12/27, 44.4%), atrial fibrillation (1/27, 3.7%), hyperlipidemia (10/27, 37%), hyperhomocysteinemia (6/27, 22.2%), smoking history (10/27, 37%; 9/15, 60% for men; 1/12, 8.3% for women), and excessive alcohol consumption history (7/27, 25.9%; 7/15, 46.7% for men; 0 for women) were observed in our patient population. Based on TOAST classification, 1 patient had large artery atherosclerosis (7.14%), 23 had small vessel occlusion (SVO; 85.2%), and 3 patients were unidentified due to lack of cerebral angiography. The thalamic blood supply classification were as follows: 23 (85.2%), inferolateral territory; 1 (3.7%), tuberothalamic territory; 2 (7.4%), combination of tuberothalamic and paramedian arteries; 1 (3.7%), combination of inferolateral and paramedian arteries; 0, posterior choroidal arteries. During the 8-year follow-up, 3 patients died of colon cancer, multi-organ failure, and kidney failure, respectively; 7 presented with a recurrent stroke; while 10 recovered well with their risk factors under control. In conclusion, our cohort of pure thalamic infarcts were mainly due to SVO (TOAST), with hypertension as the main risk factor, and the inferolateral artery as the most implicated arterial territory. Less severe outcome or stroke recurrence are identified in long-term follow-up of pure thalamic infarcts. Other comorbidities would be cause of death in aged patients.

Multicenter Observational Study on Detection of Atrial Fibrillation Using Insertable Cardiac Monitors in Patients With Cryptogenic Stroke in Japan : LOOK Registry - Study Design and Characteristics

2021 ◽  
Author(s):  
Satoshi Suda ◽  
Takehiro Katano ◽  
Kazuo Kitagawa ◽  
Yasuyuki Iguchi ◽  
Shigeru Fujimoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Observational Study ◽  
Cryptogenic Stroke ◽  
Cognitive Status ◽  
Current Status ◽  
Stroke Recurrence ◽  
Multicenter Observational Study ◽  
Stroke Registry ◽  
The Look

Abstract Background Paroxysmal atrial fibrillation (AF) is a probable cause of cryptogenic stroke (CS) and AF detection and treatment are important for secondary prevention of stroke. Insertable cardiac monitors (ICMs) are clinically effective in screening for AF and superior to conventional CS follow-up. However, available data are primarily derived from small retrospective studies within Asian cohorts and there is a lack of detailed analyses of differences in patients with and without AF. In this study, we aim to identify the incidence of AF detection and risk stratification criteria within the LOOK (multicenter observational study on detection of atrial fibrillation using insertabLe cardiac mOnitors in patients with cryptOgenic stroKe) registry. Results may benefit patients with CS by enabling clinical practitioners to better predict occult AF and stroke via ICMs. Methods The LOOK registry is a multicenter, prospective, observational study evaluating the proportion, timing, and characteristics of AF detection in patients diagnosed with CS via ICMs. Patient enrolment in this ongoing study started in February 2020 with a target of 200 patients. We are investigating first detection of AF (lasting > 2 minutes) during follow-up at 6, 12, and 24 months via ICM implantation. Patient characteristics, medical history, serum biomarkers, magnetic resonance neuroimaging, atrial cardiomyopathy markers, electrocardiogram readings (including 24-hour Holter electrocardiogram readings), transesophageal echocardiography, cognitive status, stroke recurrence, and functional outcomes are compared between patients with and without AF in this study. Discussion This prospective, multicenter study aims to identify the current status of AF detection in CS patients in Japan. The findings of this study will help identify AF markers and generate a risk scoring system with a novel and superior screening algorithm for occult AF detection, while identifying candidates for ICM implantation and informing the development of diagnostic criteria for CS. Trial registration: UMIN000039809; Registered on 13 Mar 2020

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