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Published on: February 28, 2012
Real-World Experience with Insertable Cardiac Monitors to Find Atrial Fibrillation in Cryptogenic Stroke
Paul D Ziegler1, John D Rogers, Scott W Ferreira
1Medtronic Cardiac Rhythm Heart Failure, Mounds View, Minn., USA.
Insights
Real-world data shows insertable cardiac monitors (ICMs) detect atrial fibrillation (AF) in 12.2% of cryptogenic stroke patients within 6 months. Longer monitoring periods than 30 days may be needed for effective AF detection in these patients.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Atrial fibrillation (AF) detection in cryptogenic stroke patients is crucial for preventing recurrent events.
- Previous studies focused on select populations, limiting real-world insights.
- The incidence of AF in a large, unselected cohort using insertable cardiac monitors (ICMs) after cryptogenic stroke remains understudied.
Purpose of the Study:
- To investigate the real-world incidence and characteristics of AF detected by ICMs in cryptogenic stroke patients.
- To compare AF detection rates with findings from the CRYSTAL AF study.
- To evaluate the optimal duration for cardiac rhythm monitoring in this patient group.
Main Methods:
- Utilized de-identified data from the Medtronic DiscoveryLink™ database.
- Included patients who received an ICM (Reveal LINQ™) for AF detection post-cryptogenic stroke.
- Quantified AF detection rates (≥2 min episodes) using Kaplan-Meier estimates at 1 and 6 months.
Main Results:
- 1,247 patients were analyzed with a median follow-up of 182 days.
- AF was detected in 147 patients (11.8%), with detection rates of 4.6% at 30 days and 12.2% at 182 days.
- This represents a 37% increase in detection compared to the CRYSTAL AF trial at 6 months; median AF episode duration was 3.4 hours.
Conclusions:
- Real-world AF incidence in cryptogenic stroke patients monitored with ICMs supports CRYSTAL AF findings.
- Continuous cardiac rhythm monitoring beyond 30 days is suggested for cryptogenic stroke evaluations.
- ICMs provide valuable data for optimizing stroke prevention strategies.
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.
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