scholarly journals Supraventricular Runs in 7-Day Holter Monitoring Are Related to Increased Incidence of Atrial Fibrillation in a 3-Year Follow-Up of Cryptogenic Stroke Patients Free from Arrhythmia in a 24 h-Holter

2021 ◽  
Vol 8 (7) ◽  
pp. 81
Author(s):  
Andrzej Kułach ◽  
Milena Dewerenda ◽  
Michał Majewski ◽  
Anetta Lasek-Bal ◽  
Zbigniew Gąsior
Keyword(s):  
Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Holter Monitoring ◽  
Ecg Monitoring ◽  
Stroke Patients ◽  
Long Term Monitoring ◽  
In Cis ◽  
Term Monitoring

Introduction: Silent atrial fibrillation (AF) is a common cause of cryptogenic ischemic stroke (CIS). The 24-h-Holter is insufficient to reveal an occult arrhythmic cause of stroke and the strategy to select the patients for long-term monitoring is missing. Objectives: The aim of the study was to evaluate 7-day-Holter monitoring to identify cases with the arrhythmic cause of stroke in CIS patients in whom 24-h-Holter was free from arrhythmia, and to assess the relation between supraventricular (SV) runs in baseline Holter and the incidence of AF in a 3-year follow-up period. Methods: 78 patients (aged 60 ± 9 years, 45 males) with CIS and no arrhythmic findings in 24-h-Holter were enrolled. All patients had 7-day-Holter monitoring after stroke and were followed up for 36 months, and then 7-day Holter was repeated. We assessed SV runs (≥5 QRS) in the initial 7-day Holter and analyzed the relation of the findings with clinical characteristics of novel AF episodes revealed early after stroke and during a 3-year follow-up. Results: Baseline 7-day-Holter revealed SV runs in 36% of patients and AF in 9% of cases. During a 3-year follow-up, 8 additional cases were confirmed, both in standard care and in repeated Holter (a total of 19% of AF cases). There was no difference with regard to CHADS2VASc score (3.6 ± 1.1 vs. 3.4 ± 1.5; p = NS) and left atrium parameters between patients with SV runs and the non-arrhythmic group. Patients with SV runs had a higher incidence of AF both after stroke and in a 3-year follow-up (46% vs. 4%, RR 11.6, p < 0.001). In 8 cases, patent foramen ovale was detected during follow-up. Conclusions: A strategy of baseline 7-day-Holter monitoring after stroke allows for disclosing SV runs in every third case and AF in 9% of stroke survivors. Patients with SV runs have a higher incidence of AF (RR 11.6, p < 0.001) and should be considered for extended continuous ECG monitoring.

Abstract 17109: Real World Assessment of Atrial Fibrillation and Other Arrhythmias After Cryptogenic Stroke

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Naga Venkata K Pothineni ◽  
Uyanga Batnyam ◽  
Jeffrey Arkles ◽  
John Bullinga ◽  
Brett L CUCCHIARA ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trials ◽  
Real World ◽  
Cryptogenic Stroke ◽  
Premature Ventricular Contractions ◽  
Entire Cohort ◽  
Detection Algorithms ◽  
Term Monitoring

Introduction: Long-term monitoring for atrial fibrillation (AF) is recommended in patients, who have experienced a cryptogenic stroke (CS). Clinical trials have identified AF in ~30% of patients after 3 years of continuous monitoring with insertable cardiac monitors (ICMs). Hypothesis: In a real-world analysis from a large academic healthcare system, we sought to evaluate a CS population with ICMs and a) determine the yield of AF and subsequent initiation of anticoagulation; and b) identify the presence of other arrhythmias. Methods: We evaluated all CS patients who had received an ICM between October 2014 and April 2020. We manually reviewed all stored electrocardiograms that were automatically labeled as AF by the ICM and adjudicated them as either a) AF or b) other cardiac arrhythmia including premature atrial contractions (PAC), premature ventricular contractions (PVC), supraventricular tachycardia (SVT), or nonsustained ventricular tachycardia (NSVT). Results: A total of 84 CS patients with ICMs were included: 51% men, mean age 63 years, and mean CHA 2 DS 2 -VASc 4.1. Over a median follow-up duration of 15.7 months, there were 34 patients (40% of the cohort) who did not have any AF alerts. In the remaining 50 patients, there were 960 stored electrograms that were adjudicated. Only 154 recordings from 16 patients (19% of the entire cohort) were adjudicated as AF. Oral anticoagulation was initiated in all these patients with adjudicated AF. The remaining tracings, which had been automatically categorized by the ICM as AF alerts, represented 34 patients (40% of the cohort). These patients had other arrhythmias including frequent PACs or PVCs, SVT, or NSVT. Conclusions: Compared to clinical trials, our real-world assessment suggests that the yield of AF following CS is lower - approximately 20%. Our findings highlight the importance for reviewing device tracings given the high rates of false positive for AF. Further research to refine AF detection algorithms in ICMs is needed.

scholarly journals The culprit of cryptogenic stroke: the short-term versus long-term atrial fibrillation detection rate in a tertiary care centre

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
F Wouters ◽  
P Vandervoort ◽  
D Mesotten ◽  
D Verhaert ◽  
J Vranken ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Unit ◽  
Detection Rate ◽  
Cryptogenic Stroke ◽  
Smartphone Application ◽  
Short Term ◽  
Long Term Monitoring ◽  
One Year ◽  
Term Monitoring

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Limburg Clinical Research Center OnBehalf Mobile Health Unit & Future Health Background Cryptogenic stroke (CS) and transient ischemic attack (TIA) patients have no determined aetiology at discharge. A possible cause for stroke is atrial fibrillation (AF). AF occurs in 20%-40% of the CS patients and diagnosis is highly dependent on monitoring duration. A long-term monitoring method is the insertable loop recorder (ILR), recommended by the European Society of Cardiology. However, this is not routinely used in Belgium despite reimbursement. Purpose This study aims to determine the AF detection rates of different methods used in clinical practice, ranging from short-term monitoring (monitoring in a stroke unit, 12-lead electrocardiogram (ECG), and 24-hour ECG), seven-day Holter, and long-term monitoring (smartphone application and ILR). Methods A monocentric, retrospective study was conducted in adults with CS or TIA between 1/01/17 - 1/01/20. Data were collected from the electronic medical record. The primary endpoint was the detection rate and time until first AF detection. Results A total of 368 patients suffered from a CS or TIA. Most of them were monitored in the stroke unit (96%) or with a 12-lead ECG (93%). A 24-hour ECG was used in 26%, a seven-day Holter in 38%. For long-term monitoring, a smartphone application was used in 3%. ILRs were inserted in 6%, with a median time of 102 days after stroke (IQR: 48-321). One year after ILR insertion, AF was detected in 23%. AF detection increased with monitoring duration, as shown in the figure, except for 24-hour ECG, which detected no AF. Therefore, the AF detection rate was different between short-term monitoring (5%)  and seven-day Holter (10%; p=.034), and short- and long-term monitoring (16%; p=.01). The age of CS patients without AF (Mdn = 71yr) was lower than those with AF (Mdn = 79yr; p=.001). The National Institutes of Health Stroke Scale (NIHSS) and the CHA2DS2-VASc score of patients without AF (Mdn = 3) was lower than those with AF (Mdn = 6, p&lt;.001; Mdn = 4, p=.004 respectively). The one-year mortality of patients with AF was 15% compared to 8% for patients without AF. No patients with an ILR deceased within one year after the stroke. Conclusions Detection of AF was associated with higher age, NIHSS, and CHA2DS2-VASc scores. These variables can be used to select patients for the insertion of ILRs. The detection rate of AF was significantly higher with long-term monitoring and seven-day Holter compared to short-term monitoring. However, only 38% of the patients were monitored for a week, and only 6% had an ILR inserted. Therefore, despite guideline recommendations, long-term cardiac monitoring is underutilised in this population of CS patients. Nevertheless, AF was still detected in 14% of CS patients within one year after the stroke. These findings emphasise the need for more monitoring with a seven-day Holter, smartphone app, and ILR in this patient population. Consequently, this will result in more accurate treatment of AF as secondary prevention of CS. Abstract Figure. Time to first AF detection after stroke

Abstract 209: Final Results of the Surprise Study:Long-term Monitoring For Atrial Fibrillation (AF) in Cryptogenic Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Louisa M Christensen ◽  
Derk Krieger ◽  
Søren Højberg ◽  
Ole D Pedersen ◽  
Finn M Karlsen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Final Analysis ◽  
Stroke Onset ◽  
Minor Stroke ◽  
Loop Recorder ◽  
Kaplan Meier ◽  
Long Term Monitoring ◽  
Term Monitoring

Background The true frequency of AF in patients with cryptogenic stroke or TIA is not well defined. The aim was to estimate the frequency and burden of AF in patients with apparent cryptogenic minor stroke or TIA by long term monitoring providing complete data on arrhythmia occurrence. Methods Patients with minor stroke or DWI-positive TIA were included if stroke causation remained unknown during standardized work up including 24 hours telemetry. A Reveal XT®, an atrial fibrillation sensitive loop-recorder, was implanted subcutaneously allowing continuous monitoring for up to 3 years. Arrhythmia episodes were adjudicated by senior consultant cardiologist. Endpoints include episodes of AF, time and burden of AF. A total of 84 patients were included and had a minimum of three months of monitoring before final analysis. Five patients were explanted due to local infections or discomfort. (fig.2) Results In 13 patients (15.5 %) AF was documented by long term monitoring. The mean burden of AF was 2 hours pr day monitored, varying from less than a minute to 17 hours pr day monitored. (median 20 minutes pr day monitored) Kaplan Meier (fig.1) presents time from stroke onset to first AF event, mean time was 106,0 days (SD 47,9 days) Time from stroke onset to implantation was at a median of 56 days. (Mean 80 days, SD 74,9). Logistic regression analysis including all elements of CHADS2VAS found increasing risk of AF with an OR = 1.096 (p=0.015) with increasing age in years. CHADS 2 VAS score was 4.14 in the AF group vs. 3.24 (p=0.03). Conclusion Paroxysmal AF is frequent and brief in patients with cryptogenic stroke. Long term monitoring resulted in change of treatment in one out of 6 patients in this cohort.

scholarly journals 72 hour Holter monitoring, 7 day Holter monitoring, and 30 day intermittent patient-activated heart rhythm recording in detecting arrhythmias in cryptogenic stroke patients free from arrhythmia in a screening 24 h Holter

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 697-701
Author(s):  
Andrzej Kułach ◽  
Milena Dewerenda ◽  
Michał Majewski ◽  
Anetta Lasek-Bal ◽  
Zbigniew Gąsior
Keyword(s):  
Cryptogenic Stroke ◽  
Heart Rhythm ◽  
Holter Monitoring ◽  
Diagnostic Value ◽  
Ecg Monitoring ◽  
Stroke Patients ◽  
The Mean ◽  
In Cis ◽  
Electrocardiogram Ecg ◽  
Better Than

AbstractIntroductionAccording to recent studies, silent atrial fibrillation (AF) is a common cause of cryptogenic ischemic stroke (CIS). 12-lead electrocardiogram (ECG) and 24 h Holter are not efficient to reveal an occult arrhythmic cause of stroke.ObjectivesThe aim of the study was to evaluate 72 h Holter, 7 day Holter monitoring, and intermittent single-lead ECG recording in patients with CIS to identify cases with the arrhythmic cause of stroke in patients with CIS in whom 24 h ECG Holter was free from arrhythmia.Methods72 patients (aged 60 ± 9 years, 44 males) with CIS and no arrhythmic findings in 24 h Holter were enrolled. All patients had 7 day Holter monitoring and received handheld ECG recorder (CheckMe, Viatom) for ambulatory 30 ± 3 days ECG recording. AF, supraventricular tachycardia (SVT runs of ≥5 QRS), and other arrhythmias were assessed in the first 72 h of Holter recording, in 7 day-recording, and in handheld ECG strips.Results72 h-recording revealed AF in four cases (5.6%) and SVT in 18 (25%) cases. 7 day Holter confirmed AF in seven patients (10%) and SVT in 27 patients (37.5%). There was no difference in regards to CHADS2VASc score between patients with SVT and non-arrhythmic group (3.6 ± 1.1 vs 3.4 ± 1.6; p = NS). Symptoms did not correlate with findings. Patient-activated handheld ECG recorders were used with good compliance. The mean number of recordings was 49 ± 30. Except for PACs, there was only one case of AF documented in 3,531 strips.Conclusions7 day Holter performs better than 72 h and reveals supraventricular arrhythmias in every third and AF in 10% of CIS patients who were free from arrhythmia in 24 h ECG monitoring. 30 day intermittent ECG monitor does not yield diagnostic value in CIS.

First clinical experience with the wearable cardiac rhythm long-term monitoring cardioskin device

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Guedeney ◽  
J Silvain ◽  
F Hidden-Lucet ◽  
C Maupain ◽  
S Dinanian ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Cardiac Rhythm ◽  
Cardiac Monitoring ◽  
Funding Source ◽  
Single Center ◽  
Long Term Monitoring ◽  
Monitoring Devices ◽  
Term Monitoring

Abstract Background There are only limited options for long-term cardiac monitoring devices readily available in clinical practice for outpatients. Holter monitoring devices are limited by the uncomfort of wires and patches, the small number of leads for analysis, the quality of recordings or the monitoring duration while insertable cardiac monitors are costly and exposed to potential local complication. Purpose To describe a single center experience with a novel wearable device for cardiac rhythm monitoring. Methods The Cardioskin™ system is a patch-free, wire-free, wearable device with rechargeable batteries that provides a high quality 15-lead electrocardiogram monitoring over 1 month (Figure 1). Data are sent using a mobile application downloaded in the patient smartphone to a central Corelab where they can be interpreted by an expert and/or the prescribing physician. An alarm signal is readily available within the Cardioskin™ device, to allow patients to indicate the presence of symptoms. In this single center retrospective registry, we provide a first report of the use of this novel device in real world practice, with indication and duration of cardiac monitoring left at the physicans “discretion”. Results From January 2019 to December 2019, the Cardioskin™ system was prescribed in 60 patients for an overall median duration of 26.5 (14–32) days. The mean age of the patients was 45±12.2 years and 24 (40%) were male. Indications for cardiac monitoring were post-Stroke, palpitation, syncope and cardiomyopathy assessment in 56%, 30%, 7% and 7% of the cases, respectively. A sustained (&gt;30 seconds) supraventricular tachycardia was detected in 4 cases, including one case of atrial fibrillation, two case of atrial tachycardia and on case of junctional tachycardia. Unsustained ventricular tachycardia and atrial fibrillation burst were detected in another 2 cases (Figure 1). There was no reported case of skin irritation by the Cardioskin™ system or abrupt interruption of the monitoring by the patients. Conclusion The Cardioskin™ system is a novel, discreet and comfortable cardiac rhythm wearable long-term monitoring device which can be used in clinical practice for broad diagnostic indications. Figure 1. Cardioskin system Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): ACTION coeur

scholarly journals Radiofrequency versus Cryoballoon Ablation of Atrial Fibrillation: An Evaluation Using ECG, Holter Monitoring, and Implantable Loop Recorders to Monitor Absolute and Clinical Effectiveness

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Karapet Davtyan ◽  
Victoria Shatakhtsyan ◽  
Hermine Poghosyan ◽  
Alexandr Deev ◽  
Alexey Tarasov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Effectiveness ◽  
Holter Monitoring ◽  
Patient Characteristics ◽  
Cryoballoon Ablation ◽  
End Point ◽  
Radiofrequency Current ◽  
Implantable Loop Recorders

Introduction. While several studies have compared the radiofrequency current (RFC) and cryoablation for the treatment of patients with atrial fibrillation (AF), no study has monitored the long-term outcomes with the usage of implantable loop recorders (ILRs). Methods. We enrolled 89 consecutive patients with nonvalvular paroxysmal AF (N=44 for RFC and N=45 for cryoballoon). The primary efficacy end point was the assessment of effectiveness for each group (RFC versus cryoballoon) when examining freedom from arrhythmia by monitoring with ECG, Holter, and implantable loop recoder (ILR). The primary safety end point compared rates of adverse events between both groups. The secondary efficacy end point examined the duration of the postablation blanking period from ILR retrieved data. Results. The mean age of the study population was 56.6±10.2 years, and the follow-up duration was 12 months. There were no differences in baseline patient characteristics between groups. At 12 months, the absolute effectiveness (measured by ILR) was 65.9% in the RFC group and 51.1% in the cryoballoon group (OR = 1.85; 95% CI: 0.79–4.35; p=0.157), and the clinical effectiveness (measured by ECG and Holter) was 81.8% in the RFC group and 55.6% in the cryoballoon group (OR = 3.6; 95% CI: 1.37–9.46; p=0.008). There was no difference in safety between both groups. Asymptomatic episodes were significantly more present in the RFC group as measured by ILRs (p<0.010). In cryoballoon group, arrhythmia episodes were recorded equally irrespective of the follow-up method (i.e., ECG and Holter versus ILR (p>0.010)). The blanking period does not seem to be as important in cryoballoon as compared to RFC. Conclusion. RFC and cryoballoon ablation had similar absolute effectiveness at 12 months. ECG and Holter were effective when assessing the efficacy of the cryoballoon ablation; however, in the RFC group, ILR was necessary to accurately assess long-term efficacy.

Abstract 176: Long Term Mortality in Acute Ischemic Stroke Patients with Nonvalvular Atrial Fibrillation According to Location and Burden of Cerebral Microbleeds

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Tae-Jin Song ◽  
Jinkwon Kim ◽  
Dongbeom Song ◽  
Yong-Jae Kim ◽  
Hyo Suk Nam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Independent Predictor ◽  
Stroke Patients ◽  
Risk Of Death ◽  
Long Term Mortality

Background: Cerebral microbleeds (CMBs) were predictive of mortality in elderly and considered as a putative marker for risk of intracranial hemorrhage. Stroke patients with non valvular atrial fibrillation (NVAF) require anticoagulation, which increases the risk of hemorrhages. We investigated association of CMBs with the long term mortality in acute ischemic stroke patients with NVAF. Methods: During 6 years , consecutive ischemic stroke patients who had NVAF and who had undergone brain MRI with a gradient-recalled echo sequence were enrolled. Long-term mortality and causes of death were identified using data from Korean National Statistical Office. Survival analysis was performed whether the presence, number and location of CMBs were related with all causes, cardiovascular, and cerebrovascular mortality during follow-up. Results: Total 506 patients were enrolled during the study period and were followed up for median 2.5 years. CMBs were found in 30.8% of patients (156/506). Oral anticoagulation with warfarin was prescribed at discharge in 477 (82.7%) patients. During follow up, 177 (35%) patients died and cerebrovascular death was noted in 93 patients (81 ischemic stroke and 12 hemorrhagic stroke). After adjusting age, sex and significant variables in univariate analysis (p<0.1), multiple CMBs (≥5) were the independent predictor for all-cause, cardiovascular and ischemic stroke mortalities. The strictly lobar CMBs were associated with hemorrhagic stroke mortality in multivariate Cox regression analysis (HR 4.776, p=0.032) (Figure 1). Conclusions: Multiple CMBs were the independent predictor for the long term mortality in stroke patients with NVAF. Among them, patients with strictly lobar CMBs had a high risk of death due to hemorrhagic stroke. Our findings suggest that detection of CMBs in stroke patients with NVAF are of clinical relevance for predicting long term outcome and that particular concern is necessary in those with strictly lobar CMBs for their increased risk of death due to hemorrhagic stroke. Figure 1.

Abstract 18649: Long-term Outcome and the Mechanisms of Pulmonary Antrum Radial-linear Ablation in Patients With Paroxysmal Atrial Fibrillation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Xue Zhao ◽  
Jianqiang Hu ◽  
Yan Huang ◽  
Yawei Xu ◽  
Yanzhou Zhang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Holter Monitoring ◽  
Pericardial Tamponade ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Follow Up ◽  
One Year

Objectives: The aim of this study was to determine the mechanisms and effectiveness of pulmonary antrum radial-linear (PAR) ablation in comparison with pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (AF) after a long-term follow-up. Background: The one-year follow up data suggested that PAR ablation appeared to have a better outcome over the conventional PVI for paroxysmal AF. Methods: The enrollment occurred between March, 2011, and August, 2011, with the last follow-up in May, 2014. A total of 133 patients with documented paroxysmal AF were enrolled from 5 centers and randomized to PAR group or PVI group. Event ECG recorder and Holter monitoring were conductedduring the follow-up for all patients. Results: The average procedure time was 151±23 min in PAR group and 178±43 min in PVI group ( P <0.001). The average fluoroscopy time was 21±7 min in PAR group and 27±11 min in PVI group ( P= 0.002). AF triggering foci were eliminated in 59 patients (89.4%) in PAR group, whereas, only 4 patients (6.0%) in PVI group (P<0.001).At median 36 (37-35) months of follow-up after single ablation procedure, 43 of 66 patients in PAR group (65%) and 28 of 67 patients in PVI group (42%) had no recurrence of AF off antiarrhythmic drug (AAD) (P=0.007); and 47 of 66 patients in PAR group (71%) and 32 of 67 patients in PVI group (48%) had no recurrence of AF with AAD (P=0.006). At the last follow-up, the burden of AF was significantly lower in PAR group than in PVI group (0.9% ± 2.3% vs 4.9% ± 9.9%;90th percentile, 5.5% vs 19.6%; P=0.008). No major adverse event (death, stroke, PV stenosis) was observed in all the patients except one case of pericardial tamponade. Conclusions: PAR ablation is a simple, safe, and effective strategy for the treatment of paroxysmal AF with better long-term outcome than PVI. PAR ablation might exhibit the beneficial effect on AF management through multiple mechanisms. Registration: ChiCTR-TRC-11001191

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