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Published on: January 18, 2018
Neurologist-Led Management of Implantable Loop-Recorders After Embolic Stroke of Undetermined Source
Slaven Pikija1, Cornelia Rösler1, Ursula Leitner1
1Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
Insights
Neurologists can effectively manage long-term monitoring for atrial fibrillation (AFib) in patients with embolic stroke of undetermined source (ESUS). Earlier loop recorder implantation and specific ECG findings predict AFib detection, supporting neurologist-led care.
Area of Science:
- Neurology
- Cardiology
- Internal Medicine
Background:
- Embolic stroke of undetermined source (ESUS) accounts for a significant portion of cryptogenic strokes.
- The role of neurologists in managing long-term monitoring for atrial fibrillation (AFib) in ESUS patients requires further investigation.
Purpose of the Study:
- To evaluate the feasibility and predictors of AFib detection using implantable loop recorders (ILRs) managed by neurologists in ESUS patients.
Main Methods:
- A cohort of 131 ESUS patients receiving Reveal LINQ® ILR implantation between 2016-2020 was analyzed.
- Data collected included demographics, clinical history, ECG, and imaging. AFib detection was defined as >120s duration.
- Predictors such as PQ interval and supraventricular extrasystoles (SVEs) were assessed.
Main Results:
- 45 (34%) patients were diagnosed with AFib during a median follow-up of 504 days.
- Earlier ILR implantation after ESUS was associated with AFib detection (13 vs. 31 days).
- A prolonged PQ interval and increased SVEs on pre-implantation ECG predicted higher AFib rates.
Conclusions:
- Neurologist-led management and evaluation of ILRs in ESUS patients is feasible.
- The study identified predictors for AFib detection, with a higher frequency observed than previously reported.
- This approach supports timely AFib diagnosis and management in ESUS patients.
Introduction:
Upon completion of the workup for stroke, etiology cannot be identified in approximately one-third of the patients, with an embolic stroke of undetermined source (ESUS) accounting for around 50% of these cryptogenic etiologies. Whether management of complex long-term monitoring in order to detect suspected atrial fibrillation (AFib) could be initiated and managed through a neurologist is not sufficiently investigated.
Patients And Methods:
We recruited all consecutive patients with ESUS who received implantation after neurological adjudication of Reveal LINQ® loop recorder between January 2016 and July 2020. We collected demographic, clinical, heart- and neuroimaging, laboratory, and electrocardiographic data assessed on prolonged baseline ECG monitoring, number of supraventricular (SVEs) and ventricular (VEs) extrasystolic complexes, and from preimplantation ECG-PQ interval. AFib detection was manually supervised and determined positive when the duration was over 120 s.
Results:
We followed a total of 131 patients for a median of 504 days. There were 45 (34%) manually verified AFib diagnoses. In univariate analysis, earlier implantation after ESUS was associated with AFib detection (13 vs. 31 days, p = 0.011). In multivariate analysis, increased rate of AFib was associated with a more prolonged PQ interval (per 50-ms increase) (HR 1.99, 95% CI 1.39-2.85) and number of SVEs (HR 1.29, 95% CI 1.05-1.57) measured on pre-implantation ECG.
Conclusion:
We observed similar predictors for Afib after ESUS, albeit with higher frequency than previously reported. This study suggests that the neurologist-led decision, management, and evaluation of ILR after ESUS is feasible.
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