Toyoda Kazunori, Okumura Ken, Hashimoto Yoichiro, Ikeda Takanori, Komatsu Takashi, Hirano Teruyuki, Fukuda Haruhisa, Matsumoto Kazuo, Yasaka Masahiro
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.
J Stroke Cerebrovasc Dis. 2016 Aug;25(8):1829-37. doi: 10.1016/j.jstrokecerebrovasdis.2016.05.012. Epub 2016 Jun 6.
A new insertable cardiac monitor, Reveal LINQ (Medtronic, Dublin, Ireland), was approved for clinical use in Japan in March 2016 for detecting atrial fibrillation in patients who develop ischemic stroke with no clearly definable etiology even after extensive workup, so-called cryptogenic ischemic stroke. Cooperation between a specialist of the Japan Stroke Society and a trained cardiologist or cardiac surgeon is needed both for appropriate patient selection and appropriate management of the device. In this paper, the clinical significance of and diagnostic methods for cryptogenic stroke and covert atrial fibrillation are explained, along with our proposal for the clinical indications for this new device.
METHODS, RESULTS, AND CONCLUSION: The majority of cryptogenic ischemic strokes are considered to be embolic. In particular, covert atrial fibrillation is drawing attention as the causal emboligenic disease, and it was identified in 30% of patients with long-term observation using an insertable cardiac monitor. Should atrial fibrillation be present, there is a high risk of recurrent stroke, and the cardioembolic stroke that appears is generally severe. The ability to identify atrial fibrillation would be beneficial for preventing stroke recurrence, as anticoagulants can then be used as an established method of secondary prevention. Because the use of insertable cardiac monitors is somewhat invasive, and long-term care systems are also needed, patients suitable for examination using the new device would need to be identified on the basis of detailed diagnostics in accordance withcurrent medical practice in Japan.
一种新型可植入式心脏监测器Reveal LINQ（美敦力公司，爱尔兰都柏林）于2016年3月在日本获批用于临床，以检测即使经过全面检查仍无明确病因的缺血性卒中患者（即所谓的隐源性缺血性卒中）的房颤情况。对于合适的患者选择和该设备的恰当管理，需要日本卒中学会的专家与经过培训的心脏病专家或心脏外科医生合作。本文解释了隐源性卒中和隐匿性房颤的临床意义及诊断方法，以及我们对该新设备临床适应证的建议。
方法、结果与结论：大多数隐源性缺血性卒中被认为是栓塞性的。特别是，隐匿性房颤作为因果性栓塞性疾病正受到关注，使用可植入式心脏监测器进行长期观察的患者中有30%被确诊患有隐匿性房颤。如果存在房颤，复发性卒中的风险很高，而且出现的心源性栓塞性卒中通常较为严重。识别房颤对于预防卒中复发有益，因为抗凝剂可作为二级预防的既定方法使用。由于使用可植入式心脏监测器有一定的侵入性，且还需要长期护理系统，因此需要根据日本当前的医疗实践，通过详细诊断来确定适合使用该新设备进行检查的患者。
