POSTER SESSION 6 Article Swipe
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· 2015
· Open Access
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· DOI: https://doi.org/10.1093/europace/euv178
· OA: W4238331480
Background: Up to 30% of ischemic strokes are of undetermined etiology or cryptogenic.Subclinical atrial fibrillation (AF) could be the underlying cause in some cases.Current guidelines are not specific about the best strategy for AF detection.Aims: To assess the AF-detection rate and time-course in a population with cryptogenic stroke (CS) receiving an insertable cardiac monitor (ICM), in comparison to a standard outpatient strategy.Methods: Between 2005-2014, 290 patients were diagnosed with CS at our center, and received one of these two strategies for post-admission AF-detection: 1) conventional strategy, i.e. ambulatory 24h-Holter and, if negative, 7day-Holter monitoring (historical cohort, 2005-2012); 2) ICM implant during initial hospital admission (prospective cohort, 2013-2014).AF episodes lasting .1min were recorded during 1 year following CS.Results: Of the 290 patients (59% women, mean age 78 + 7, 73% with hypertension), 262 comprised the historical cohort, whereas 28 received an ICM.Patients in both groups did not differ regarding age, sex, CV risk factors, or stroke-related artery.During follow-up, AF was detected in 11.5% in the historical cohort and in 42.9% in the prospective cohort (p , 0.001).Time to AF-detection was significantly shorter with ICM (18 (15-100) vs. 60 (30-180) days, p=0.001).Survival analysis showed that, among the ICM group, most AF episodes occurred within the first month after CS, whereas the rate of AF beyond 6 months was scarce (figure).Conclusions: In patients with CS, continuous monitoring with ICM is superior to conventional strategies for AF detection.The incidence of AF in patients with CS could be extremely high, especially within the first month following CS, which alerts about the need for early monitoring in these patients.
