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Original Paper

Editor's Choice - Open Access Gateway

Real-World Experience with Insertable Cardiac Monitors to Find Atrial Fibrillation in Cryptogenic Stroke

Ziegler P.D.a · Rogers J.D.b · Ferreira S.W.c · Nichols A.J.d · Sarkar S.a · Koehler J.L.a · Warman E.N.a · Richards M.e

Author affiliations

aMedtronic Cardiac Rhythm Heart Failure, Mounds View, Minn., bScripps Clinic, La Jolla, Calif., cSt. Louis University, St. Louis, Mo., dOhio Health Heart and Vascular Physicians, Columbus, Ohio, eProMedica Physicians Cardiology, Toledo, Ohio, USA

Corresponding Author

Paul D. Ziegler

Medtronic Cardiac Rhythm Heart Failure

8200 Coral Sea Street NE

Mailstop MVN41, Mounds View, MN 55112 (USA)

E-Mail paul.david.ziegler@medtronic.com

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Cerebrovasc Dis 2015;40:175-181

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Abstract

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.

© 2015 The Author(s) Published by S. Karger AG, Basel


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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: May 28, 2015
Accepted: July 29, 2015
Published online: August 28, 2015
Issue release date: September 2015

Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 0

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED


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