Insertable cardiac monitors detected intermittent atrial fibrillation in 17% of patients with cryptogenic stroke, compared to 1.7% using 7-day Holter monitoring (P=0.0077).
Observational (n=60)
Does insertable cardiac monitor (ICM) implantation improve the detection rate of intermittent atrial fibrillation compared to 7-day Holter monitoring in patients with cryptogenic stroke?
Insertable cardiac monitors offer a significantly higher diagnostic yield for detecting occult intermittent atrial fibrillation in patients with cryptogenic stroke compared to standard 7-day Holter monitoring.
Absolute Event Rate: 17% vs 1.7%
p-value: p=0.0077
BACKGROUND AND PURPOSE: A significant number of patients with cryptogenic stroke suffer from intermittent atrial fibrillation (iAF) which was not detected during the standard diagnostic procedures. We investigated whether implantation of an insertable cardiac monitor (ICM) is feasible in patients with cryptogenic stroke, and compared the iAF detection rate of the ICM with 7-day Holter monitoring. METHODS: Sixty patients (median age 63; interquartile range, 48.5-72 years) with acute cryptogenic stroke were included. ICM was implanted 13 days (interquartile range; 10-65 days) after the qualifying event. Seven-day Holter was performed after the ICM was implanted. RESULTS: The iAF was detected by the ICM in 10 patients (17%; 95% CI, 7% to 26%). Only 1 patient (1.7%; 95% CI, 0% to 5%) had iAF during 7-day Holter monitoring as well (P=0.0077). Episodes of iAF lasting 2 minutes or more were detected 64 (range, 1-556) days after implantation. There were no recurrent strokes during the observation period. The implantation procedure was well tolerated with no adverse events; the daily data transmission protocol was easy to handle by the patients. CONCLUSIONS: ICM implantation for the detection of iAF during outpatient follow-up is feasible in patients with cryptogenic stroke. ICMs offer a much higher diagnostic yield than 7-day Holter monitoring.
Ritter et al. (Fri,) conducted a observational in acute cryptogenic stroke (n=60). Insertable cardiac monitor (ICM) vs. 7-day Holter monitoring was evaluated on Detection of intermittent atrial fibrillation (iAF) (p=0.0077). Insertable cardiac monitors detected intermittent atrial fibrillation in 17% of patients with cryptogenic stroke, compared to 1.7% using 7-day Holter monitoring (P=0.0077).
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