Evaluation of Paroxysmal Atrial Fibrillation Detection Using Short-Term Monitoring With an Insertable Cardiac Monitor in Patients With Cryptogenic Stroke: Initial Clinical Results

Figure 1. Study Flow Diagram Patients diagnosed with cryptogenic stroke received ICM implantation and were followed for one year, after which the devices were explanted. ICM: insertable cardiac monitor

Figure 2. Brain MRI and Electrocardiographic Findings on Admission in Case 1 (A) Brain MRI on admission revealed no evidence of new ischemic lesions. (B) Magnetic resonance angiography (MRA) of the head demonstrated no arterial stenosis or occlusion. (C) Cervical MRA showed no evidence of stenosis or occlusion in the carotid arteries. (D) The 12-lead electrocardiogram at admission showed a heart rate of 58 beats per minute with sinus rhythm.

Figure 3. Brain MRI and Electrocardiographic Findings on Admission in Case 2 (A) Diffusion-weighted imaging (DWI) of the brain revealed acute ischemic infarctions in the left medulla and left cerebellum (arrowheads). (B) MRA of the head demonstrated no arterial stenosis or occlusion. (C) The 12-lead electrocardiogram at admission showed a heart rate of 68 beats per minute with sinus rhythm.

Figure 4. Brain MRI and Electrocardiographic Findings on Admission in Case 3 (A) Diffusion-weighted imaging revealed multiple acute infarcts in the posterior limb of the left internal capsule (arrowheads). (B) Intracranial magnetic resonance angiography (MRA) showed no evidence of stenosis or occlusion in the major cerebral arteries. (C) Cervical MRA demonstrated no significant stenosis in the common or internal carotid arteries. (D) The 12-lead electrocardiogram at admission showed a heart rate of 94 beats per minute with sinus rhythm.

Figure 5. Brain MRI Findings at the Time of Stroke Recurrence (Day 43 of Hospitalization) (A) A new infarct was observed in the right putamen (arrowheads). (B) Intracranial magnetic resonance angiography (MRA) revealed no evidence of stenosis or occlusion in the major cerebral arteries.

Figure 6. Questionnaire Results Q1. Two patients scored 0, and one scored 5; two patients reported feeling reassured by ICM use. Q2. One patient scored 10, and two scored 4; two patients experienced chest discomfort following ICM implantation. Q3. Scores were 4, 5, and 10; one patient reported improvement in chest discomfort after ICM removal. Q4. Scores were 0, 2, and 4; all patients stated that a one-year monitoring period was more appropriate than prolonged monitoring of 4.5 to 6 years. ICM: insertable cardiac monitor

Figure 7. Ten-Point Likert Scale Used in This Study A 10-point Likert scale was employed to evaluate patient perceptions. In this study, a Likert scale was employed that was specifically developed for the purposes of this research. Responses were interpreted as follows: scores ≤4 were classified as “agree,” 5 as “neither,” and ≥6 as “disagree.”