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Ultra‐early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic stroke
Author(s) -
CuadradoGodia E.,
Benito B.,
Ois A.,
Vallès E.,
RodríguezCampello A.,
GiraltSteinhauer E.,
Cabrera S.,
Alcalde O.,
JiménezLópez J.,
JiménezConde J.,
MartíAlmor J.,
Roquer J.
Publication year - 2020
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.14061
Subject(s) - medicine , atrial fibrillation , stroke (engine) , cohort , subclinical infection , cardiology , prospective cohort study , cardiac monitoring , mechanical engineering , engineering
Background and purpose Subclinical atrial fibrillation ( AF ) is known to underlie a number of cases of cryptogenic stroke (CrS). However, there is need to define the most effective strategy for AF detection. The diagnostic usefulness was analysed of a strategy based on ultra‐early continuous monitoring in patients with CrS in terms of AF detection, oral anticoagulation treatment and stroke recurrence, in comparison to a standard outpatient strategy. Methods Patients with ischaemic stroke of undetermined origin and confirmed to be cryptogenic after extensive work‐up were searched for AF with (i) a conventional strategy (historical cohort, n = 101) with serial electrocardiograms and 24‐h Holter monitoring or (ii) an ultra‐early monitoring strategy with insertable cardiac monitor ( ICM ) implanted before discharge (prospective cohort, n = 90). AF episodes lasting >1 min, anticoagulant treatment and stroke recurrence were recorded. Results During admission, AF was similarly detected in both cohorts (24% of patients). After discharge (mean follow‐up 30 ± 10 months), AF detection rates were 17/80 (21.3%) and 38/65 (58.5%) for patients in the conventional versus the ultra‐early ICM group ( P < 0.001). Up to 41% of AF cases in the ICM cohort were detected within the first month. Oral anticoagulation was initiated in 37.6% versus 65.5% ( P < 0.001) and stroke recurrence was recorded in 10.9% versus 3.3% ( P 0.04) in the conventional versus the ICM cohort. Conclusions Pre‐discharge ICM implant allows detection of AF during follow‐up in up to 58% of selected patients with CrS. Compared to a conventional strategy, ultra‐early ICM implant results in higher anticoagulation rates and a decrease in stroke recurrence.