TY - JOUR
T1 - Atrial fibrillation detection using insertable cardiac monitor after stroke: a real-world cohort study
AU - Noubiap, Jean J.
AU - Thomas, Gijo
AU - Middeldorp, Melissa E.
AU - Fitzgerald, John L.
AU - Harper, Curtis
AU - Sanders, Prashanthan
N1 - Funding Information:
Drs Jean J. Noubiap and John L. Fitzgerald are supported by a Postgraduate Scholarship from the University of Adelaide; Dr Melissa E. Middeldorp is supported by a Postdoctoral Fellowship from the University of Adelaide; Dr Prashanthan Sanders is supported by a Practitioner Fellowship from the National Health and Medical Research Council and also by the National Heart Foundation of Australia, reports having served on the advisory board of Medtronic, Abbott Medical, Boston Scientific, CathRx and PaceMate, and reports that the University of Adelaide has received on his behalf research funding, lecture and/or consulting fees from Medtronic, Abbott Medical, Boston Scientific and Microport; and Mr Curtis Harper is employed by Pacemate. Disclosure
Publisher Copyright:
© 2022 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.
PY - 2022/11/9
Y1 - 2022/11/9
N2 - Objective: This study aimed to report the real-world atrial fibrillation (AF) diagnostic yield of the implantable cardiac monitor (ICM) in patients with stroke or transient ischemic attack (TIA), and compare it to patients with an ICM for unexplained syncope. Methods: We used patient data from device clinics across the United States of America with ICM remote monitoring via PaceMate™, implanted for stroke or TIA, and unexplained syncope. Patients with known AF or atrial flutter were excluded. The outcome was AF lasting ≥2 min, adjudicated by International Board of Heart Rhythm Examiners certified cardiac device specialists. Results: We included a total of 2469 patients, 51.1% with stroke or TIA (mean age: 69.7 [SD: 12.2] years, 41.1% female) and 48.9% with syncope (mean age: 67.0 [SD: 17.1] years, 59.4% female). The cumulative AF detection rate in patients with stroke or TIA was 5.5%, 8.9%, and 14.0% at 12, 24, and 36 months, respectively. The median episode duration was 73 (interquartile range: 10–456) min, ranging from 2 min to 40.9 days, with 52.3%, 28.6%, and 4.4% of episodes lasting at least 1, 6, and 24 h, respectively. AF detection was increased by age (adjusted hazard ratio [for every 1-year increase]: 1.024, 95% confidence interval: 1.008–1.040; p =.003), but was not influenced by sex (p =.089). For comparison, the cumulative detection rate at 12, 24, and 36 months were, respectively, 2.4%, 5.2%, and 7.4% in patients with syncope. Conclusion: Patients with stroke or TIA have a higher rate of AF detection. However, this real-world study shows significantly lower AF detection rates than what has been previously reported.
AB - Objective: This study aimed to report the real-world atrial fibrillation (AF) diagnostic yield of the implantable cardiac monitor (ICM) in patients with stroke or transient ischemic attack (TIA), and compare it to patients with an ICM for unexplained syncope. Methods: We used patient data from device clinics across the United States of America with ICM remote monitoring via PaceMate™, implanted for stroke or TIA, and unexplained syncope. Patients with known AF or atrial flutter were excluded. The outcome was AF lasting ≥2 min, adjudicated by International Board of Heart Rhythm Examiners certified cardiac device specialists. Results: We included a total of 2469 patients, 51.1% with stroke or TIA (mean age: 69.7 [SD: 12.2] years, 41.1% female) and 48.9% with syncope (mean age: 67.0 [SD: 17.1] years, 59.4% female). The cumulative AF detection rate in patients with stroke or TIA was 5.5%, 8.9%, and 14.0% at 12, 24, and 36 months, respectively. The median episode duration was 73 (interquartile range: 10–456) min, ranging from 2 min to 40.9 days, with 52.3%, 28.6%, and 4.4% of episodes lasting at least 1, 6, and 24 h, respectively. AF detection was increased by age (adjusted hazard ratio [for every 1-year increase]: 1.024, 95% confidence interval: 1.008–1.040; p =.003), but was not influenced by sex (p =.089). For comparison, the cumulative detection rate at 12, 24, and 36 months were, respectively, 2.4%, 5.2%, and 7.4% in patients with syncope. Conclusion: Patients with stroke or TIA have a higher rate of AF detection. However, this real-world study shows significantly lower AF detection rates than what has been previously reported.
KW - atrial fibrillation
KW - cryptogenic stroke
KW - implantable cardiac monitor
KW - internal loop recorder
KW - real-world
KW - transient ischemic attack
UR - http://www.scopus.com/inward/record.url?scp=85142157298&partnerID=8YFLogxK
U2 - 10.1111/jce.15744
DO - 10.1111/jce.15744
M3 - Article
C2 - 36349715
AN - SCOPUS:85142157298
JO - Journal of Cardiovascular Electrophysiology
JF - Journal of Cardiovascular Electrophysiology
SN - 1045-3873
ER -