Detection of Silent Atrial Fibrillation aFter Ischemic StrOke (SAFFO) guided by implantable loop recorder: multicentre Italian trial based on stroke unit network with paired cardio-arrhythmology units (Italian Neurocardiology Unit Network)

Abstract Background A “pill-in-the-pocket” anticoagulation strategy, guided by ECG data from an implantable loop recorder (ILR), has been advocated as a clinical strategy. However, a fundamental requirement is the ability to reliably obtain daily ECG data from patients. Objective To determine the reliability of daily ECG data transfer from ILRs. Methods We evaluated patients implanted with an ILR in whom we sought to withhold oral anticoagulation (OAC) unless atrial fibrillation (AF) was detected. The ILR transmits data nightly to a bedside monitor. Once received, the data are sent to a central server. Over the course of a month, we tracked for each patient whether ECG data were received by the server. Results The study included 170 AF patients with an ILR where we planned to withhold OAC unless AF was documented. Daily ECG data were automatically transmitted and retrievable in only 36 (21%) patients. Two (1%) pts had not a single day of connectivity, 6 (4%) pts were connected <7 days, and 16 (9%) pts were connected <14 days. Wireless connectivity was lost for >48 hours in 89 (52%) patients (Figure). Most patients experienced multiple reasons for data transmission failure within the month. Conclusions To determine whether an ILR guided OAC strategy is feasible, reliable daily transmission of ECG data is a fundamental prerequisite. Current technology facilitated daily ECG data transfer in only 1/5 of patients. In the remaining, there was either extended loss of connectivity or no connectivity at all. A “pill-in-the-pocket” anticoagulation approach is currently difficult given existing hardware limitations. Funding Acknowledgement Type of funding source: None

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Efficacy of the Stand-Alone Cox-Maze IV Procedure in Patients with Longstanding Persistent Atrial Fibrillation

10.22541/au.161447486.64450291/v1 ◽

2021 ◽

Author(s):

Martha McGilvray ◽

Nadia Bakir ◽

Meghan Kelly ◽

Samuel Perez ◽

Laurie Sinn ◽

...

Keyword(s):

Atrial Fibrillation ◽

Persistent Atrial Fibrillation ◽

Implantable Loop Recorder ◽

Atrial Tachyarrhythmia ◽

Loop Recorder ◽

Factors Associated ◽

Holter Monitor ◽

Long Duration ◽

Prolonged Monitoring

Introduction: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and results in significant morbidity and mortality. The Cox-Maze IV procedure (CMP-IV) has been shown to have excellent efficacy in returning patients to sinus rhythm, but there have been few reports of late follow-up in sizable cohorts of patients with longstanding persistent AF, the most difficult type of AF to treat. Methods & Results: Between May 2003 and March 2020, 174 consecutive patients underwent a stand-alone CMP-IV for longstanding persistent AF. Rhythm outcome was assessed postoperatively for up to 10 years, primarily via prolonged monitoring (Holter monitor, pacemaker interrogation, or implantable loop recorder). Fine-Gray regression was used to investigate factors associated with atrial tachyarrhythmia (ATA) recurrence, with death as a competing risk. Median duration of preoperative AF was 7.8 years (interquartile range [IQR] 4.0-12.0 years), with 71% (124/174) having failed at least one prior catheter-based ablation. There were no 30-day mortalities. Freedom from ATAs was 94% (120/128), 83% (53/64), and 88% (35/40) at 1, 5, and 7 years, respectively. On regression analysis, preoperative AF duration and early postoperative ATAs were associated with late ATAs recurrence. Conclusion: Despite the majority of patients having a long-duration of preoperative AF and having failed at least one catheter-based ablation, the stand-alone CMP-IV had excellent late efficacy in patients with longstanding persistent AF, with low morbidity and no mortality. We recommend consideration of stand-alone CMP-IV for patients with longstanding persistent AF who have failed or are poor candidates for catheter ablation.

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Detection of Subclinical Paroxysmal Atrial Fibrillation and Its Correlation with Candidate Genes in Patients with Cryptogenic Ischemic Stroke and TIA

Acta Medica Martiniana ◽

10.2478/acm-2021-0007 ◽

2021 ◽

Vol 21 (2) ◽

pp. 42-53

Author(s):

A Petrovicova ◽

E Kurca ◽

A Andrasova ◽

J Bernatova ◽

P Blasko ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Paroxysmal Atrial Fibrillation ◽

Cryptogenic Stroke ◽

Preventive Treatment ◽

Correct Choice ◽

Control Group ◽

Nucleotide Polymorphisms ◽

Loop Recorder ◽

Ischemic Attack

Abstract Introduction: Cardioembolic etiology is assumed to be the most frequent cause of cryptogenic strokes. The detection of subclinical paroxysmal atrial fibrillation (AF) is important in the correct choice of preventive treatment. The aim of this prospective study was to detect the incidence of AF in patients with a cryptogenic stroke or transient ischemic attack (TIA) and to evaluate the association between the presence of AF and selected single-nucleotide polymorphisms (SNP). Methods: Patients with a cryptogenic stroke/ TIA (n=100) and a control group (n=15) of volunteers without significant cardiovascular disease were included in the study during the period of 2014 to 2019. To detect AF they underwent 12 months of ECG monitoring using an implanted loop recorder (ILR). Genotyping for SNPs rs10033464, rs2200733, rs225132, and rs2106261 was performed by a high resolution melting analysis. Results: We found AF to be present in 24 (24%) patients with a cryptogenic stroke/TIA, versus no subjects in the control group. The SNPs rs2106261, rs2200733, rs225132, and rs10033464 were not found to be associated with AF in our study (p=0.240; 1.000; 0.887; 0.589). However, a weak trend for a higher frequency of rs2106261 risk allele A homozygotes was observed in the patients with AF compared to the patients without AF (0.416 vs. 0.263, p=0.073). Homozygotes for allele A of rs2106261 were also present in a significantly higher frequency in AF patients compared to the controls (0.416 vs. 0.133, p = 0.012). Conclusion: In our study paroxysmal AF was a probable etiological factor in 24% of patients with cryptogenic ischemic stroke / TIA during the 12 months of monitoring. The homozygous allele A of rs2106261 was identified to be the possible genetic risk factor of AF, but this should be verified in larger cohorts. The study has been registered at www.clinicaltrials.gov, identifier NCT02216370.

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Analysis of atrial fibrillatory rate during spontaneous episodes of atrial fibrillation in humans using implantable loop recorder electrocardiogram

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2012.05.003 ◽

2012 ◽

Vol 45 (6) ◽

pp. 723-726 ◽

Cited By ~ 10

Author(s):

Pyotr G. Platonov ◽

Martin Stridh ◽

Mirko de Melis ◽

Lubos Urban ◽

Jonas Carlson ◽

...

Keyword(s):

Atrial Fibrillation ◽

Implantable Loop Recorder ◽

Loop Recorder

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Ablation of paroxysmal atrial fibrillation during coronary artery bypass grafting: 12 months’ follow-up through implantable loop recorder

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2010.11.083 ◽

2011 ◽

Cited By ~ 8

Author(s):

Evgeny Pokushalov ◽

Alexander Romanov ◽

Alexander Cherniavsky ◽

Giorgio Corbucci ◽

Inessa Pak ◽

...

Keyword(s):

Atrial Fibrillation ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Paroxysmal Atrial Fibrillation ◽

Artery Bypass ◽

Bypass Grafting ◽

Implantable Loop Recorder ◽

Loop Recorder

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Abstract NS12: Nursing-led Intervention to Improve Use of Prolonged Arrhythmia and Polysomnography in Veterans with Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.ns12 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Sharon Bottomley ◽

Lisa Keefner ◽

Jason J Sico

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Medical Center ◽

Length Of Hospital Stay ◽

Lean Six Sigma ◽

Coordinated Care ◽

Loop Recorder ◽

Obstructive Sleep ◽

Hospitalization Period ◽

Potential Benefits

Background: Current AHA/ASA ischemic stroke prevention guidelines provide updated recommendations regarding prolonged arrhythmia monitoring to detect occult atrial fibrillation and polysomnography referral (PSG) for obstructive sleep apnea (OSA) assessment. While these assessments are traditionally considered “outpatient” testing, we sought to determine the feasibility of starting these referrals during the hospitalization period. Methods: We used Lean Six Sigma process improvement methods to process map the current and future states of obtaining prolonged arrhythmia monitoring and PSG at a single VA Medical Center. Working with stakeholders in neurology, cardiology, and sleep medicine we devised standard operating procedures for obtaining referrals for these respective testing during hospitalization. A stroke nurse coordinated all referrals. Results: Our single site intervention period was from 10/1/2015 to 2/29/2016, during which 21 patients were admitted to the neurology service with an ischemic stroke. At baseline, no patients received orders by hospital discharge for prolonged arrhythmia monitoring or PSG. Potential benefits and adverse effects of testing were discussed with Veterans. Of the twelve patients (57.1%) eligible for prolonged arrhythmia monitoring, half the patients agreed to the testing and were discharged with either a Holter monitor/implantable loop recorder. Of the 18 patients (85.7%) eligible for PSG, six agreed to the testing, with one patient receiving testing during hospitalization and the remaining patients received PSG after discharge. One Veteran was diagnosed with atrial fibrillation, whereas all Veterans receiving PSG were diagnosed with varying degrees of OSA. Positive test results initiated referrals to appropriate specialists for additional management. Length of hospital stay was not increased in order to receive the additional coordinated care. Conclusions: Implementation of a nursing coordinated program designed to improve delivery of guideline concordant post stroke arrhythmia monitoring and OSA assessment could be feasibly implemented using existing infrastructure without prolonging length of stay.

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