Department of Neurology, University of Muenster, Muenster, Germany.
Stroke. 2013 May;44(5):1449-52. doi: 10.1161/STROKEAHA.111.676189. Epub 2013 Feb 28.
A significant number of patients with cryptogenic stroke suffer from intermittent atrial fibrillation (iAF) which was not detected during the standard diagnostic procedures. We investigated whether implantation of an insertable cardiac monitor (ICM) is feasible in patients with cryptogenic stroke, and compared the iAF detection rate of the ICM with 7-day Holter monitoring.
Sixty patients (median age 63; interquartile range, 48.5-72 years) with acute cryptogenic stroke were included. ICM was implanted 13 days (interquartile range; 10-65 days) after the qualifying event. Seven-day Holter was performed after the ICM was implanted.
The iAF was detected by the ICM in 10 patients (17%; 95% CI, 7% to 26%). Only 1 patient (1.7%; 95% CI, 0% to 5%) had iAF during 7-day Holter monitoring as well (P=0.0077). Episodes of iAF lasting 2 minutes or more were detected 64 (range, 1-556) days after implantation. There were no recurrent strokes during the observation period. The implantation procedure was well tolerated with no adverse events; the daily data transmission protocol was easy to handle by the patients.
ICM implantation for the detection of iAF during outpatient follow-up is feasible in patients with cryptogenic stroke. ICMs offer a much higher diagnostic yield than 7-day Holter monitoring.
相当数量的隐源性卒中患者存在间歇性心房颤动（iAF），但在标准诊断程序中并未检测到。我们研究了在隐源性卒中患者中植入可插入式心脏监测仪（ICM）是否可行，并比较了 ICM 与 7 天 Holter 监测的 iAF 检测率。
共纳入 60 例（中位年龄 63 岁；四分位间距 48.5-72 岁）急性隐源性卒中患者。在符合条件的事件发生后 13 天（四分位间距 10-65 天）植入 ICM。植入 ICM 后进行 7 天 Holter 监测。
ICM 检测到 10 例患者（17%；95%CI，7%至 26%）存在 iAF。仅 1 例患者（1.7%；95%CI，0%至 5%）在 7 天 Holter 监测期间也存在 iAF（P=0.0077）。植入后 64 天（范围 1-556 天）检测到持续时间 2 分钟或更长时间的 iAF 发作。观察期间无复发性卒中。植入过程耐受良好，无不良事件；患者易于处理每日数据传输协议。
在隐源性卒中患者的门诊随访中，植入 ICM 以检测 iAF 是可行的。ICM 提供的诊断率远高于 7 天 Holter 监测。
