Real-world monitoring with an insertable cardiac monitor after cryptogenic stroke detected atrial fibrillation in 12.2% of patients at 6 months.
Observational (n=1,247)
Does continuous cardiac rhythm monitoring with an insertable cardiac monitor improve the detection of atrial fibrillation in patients with cryptogenic stroke?
Real-world use of insertable cardiac monitors after cryptogenic stroke yields a 12.2% AF detection rate at 6 months, validating clinical trial data and suggesting monitoring beyond the guideline-recommended 30 days is warranted.
BACKGROUND: The characteristics of atrial fibrillation (AF) episodes in cryptogenic stroke patients have recently been explored in carefully selected patient populations. However, the incidence of AF among a large, real-world population of patients with an insertable cardiac monitor (ICM) placed for the detection of AF following a cryptogenic stroke has not been investigated. METHODS: Patients in the de-identified Medtronic DiscoveryLink™ database who received an ICM (Reveal LINQ™) for the purpose of AF detection following a cryptogenic stroke were included. AF detection rates (episodes ≥2 min) were quantified using Kaplan-Meier survival estimates at 1 and 6 months and compared to the CRYSTAL AF study at 6 months. The time to AF detection and maximum duration of AF episodes were also analyzed. RESULTS: A total of 1,247 patients (age 65.3 ± 13.0 years) were followed for 182 (IQR 182-182) days. A total of 1,521 AF episodes were detected in 147 patients, resulting in AF detection rates of 4.6 and 12.2% at 30 and 182 days, respectively, and representing a 37% relative increase over that reported in the CRYSTAL AF trial at 6 months. The median time to AF detection was 58 (IQR 11-101) days and the median duration of the longest detected AF episode was 3.4 (IQR 0.4-11.8) h. CONCLUSIONS: The real-world incidence of AF among patients being monitored with an ICM after a cryptogenic stroke validates the findings of the CRYSTAL AF trial and suggests that continuous cardiac rhythm monitoring for periods longer than the current guideline recommendation of 30 days may be warranted in the evaluation of patients with cryptogenic stroke.
Ziegler et al. (Thu,) conducted a observational in Cryptogenic stroke (n=1,247). Insertable cardiac monitor (Reveal LINQ) vs. CRYSTAL AF trial (historical) was evaluated on AF detection rates (episodes ≥2 min) at 6 months. Real-world monitoring with an insertable cardiac monitor after cryptogenic stroke detected atrial fibrillation in 12.2% of patients at 6 months.