Yield of Implantable Cardiac Monitoring For Atrial Fibrillation Detection and Stroke Recurrence in Patients With Cryptogenic Stroke : a Case-Control Study

• Main Author: Defteraios, Spyros
• Format: Web Resource
• Language: English
• Published: Morressier 01.01.2017
• DOI: 10.26226/morressier.5cb58ce9c668520010b55ec8

Background & Aims:The optimal diagnostic strategy for atrial fibrillation detection (AF) in patients with cryptogenic stroke (CS) has not been determined. The present case-control study sought to compare the yield of implantable cardiac monitoring (ICM) with standard outpatient non-invasive monitoring strategy (single or multiple 24-hour Holter-ECG recordings) in AF detection, oral anticoagulation (OAC) initiation and stroke recurrence.MethodsConsecutive patients with cryptogenic stroke following a comprehensive work-up underwent ICM using Reveal LINQ during an 18-month period (cases) in a tertiary care stroke center. Cases were compared to historical controls consisting of CS patients who underwent single or multiple 24-hour Holter-ECG recordings over a 36-month period prior to ICM implementation in the same center .ResultsThe study population included 67 cases and 184 controls. AF detection was more frequent in cases than controls (18% vs 5%, p=0.002). The median elapsed time between Reveal LINQ implantation and AF detection was 72 days (IQR: 9-164). The mean AF duration detected with ICM was 448u00b1809 min. OAC initiation was more common in patients than controls (16% vs. 5%, p=0.005). The mean follow-up duration was similar in the two cohorts (13+\-11months & 14+\-13 months in cases and controls). Stroke recurrence tended to be less prevalent in cases than controls (1.5% vs. 4.9%, p= 0.297 by Fisher exact test).Conclusions:This pilot case-control study indicates that ICM appears to substantially increase the yield of AF detection and OAC initiation in CS. The former association may result in lower stroke recurrence rates in patients undergoing ICM compared to outpatient non-invasive standard cardiac monitoring.