Department of Neurology, Evangelical Hospital Bethel, Bielefeld, Germany.
Department of Cardiology, Evangelical Hospital Bethel, Bielefeld, Germany.
Thromb Haemost. 2021 Jun;121(6):826-833. doi: 10.1055/a-1346-2899. Epub 2021 Feb 16.
Undocumented atrial fibrillation (AF) is suspected as a main stroke cause in patients with embolic stroke of undetermined source (ESUS), but its prevalence is largely unknown. This prospective study therefore aimed at delineating the prevalence of AF in patients with ESUS using continuous cardiac monitoring by implantable loop recorder (ILR) with daily remote interrogation over a period of 3 years and its clinical consequences, including recurrent stroke.
In consecutive patients with an ESUS diagnosis after complete work-up, an ILR was implanted and followed by daily remote monitoring until AF was detected or a follow-up of at least 3 years was completed. Additionally, the ILR was interrogated in-hospital in 6-month intervals.
A total of 123 patients (74 male, mean age 65 ± 9 years) were enrolled and completed the 3 years study period. AF was detected in 51 patients (41.4%). In 43 of the 51 AF positive patients (84%) oral anticoagulation was established. Recurrent strokes occurred in 18 patients (14.6%) of this ESUS population, 9 of these patients being AF positive (17.6% of the AF-positive patients) and 9 being AF negative (12.5% of AF-negative patients). Patients with AF were slightly older than patients without AF (63.1 ± 8.8 vs. 67.5 ± 9.6 years, = 0.12). Other parameters such as CHADS-VASc score, infarct localization, micro- and macroangiopathy, carotid or aortic plaques, or stroke recurrence were not significantly different between groups.
In ESUS patients, early implantation of an ILR with cardiac monitoring and remote transmission over a 3-year period detected AF in 41.4% and resulted in oral anticoagulation in 84% of these patients.
在来源不明的栓塞性卒中（ESUS）患者中，未确诊的心房颤动（AF）疑似为主要卒中病因，但该病的患病率尚不清楚。因此，本前瞻性研究旨在通过植入式环路记录器（ILR）进行连续心脏监测，对 ESUS 患者进行为期 3 年的每日远程询问，以明确 AF 的患病率，并评估其临床后果，包括复发性卒中。
对经过全面检查诊断为 ESUS 的连续患者植入 ILR，并在未检出 AF 或随访至少 3 年之前进行每日远程监测。此外，每隔 6 个月对 ILR 进行院内询问。
共纳入 123 例患者（74 例男性，平均年龄 65±9 岁），并完成了 3 年的研究。51 例（41.4%）患者检出 AF。在 51 例 AF 阳性患者中，43 例（84%）接受了口服抗凝治疗。该 ESUS 人群中有 18 例（14.6%）发生了复发性卒中，其中 9 例（AF 阳性患者的 17.6%）和 9 例（AF 阴性患者的 12.5%）为 AF 阳性。AF 阳性患者略比 AF 阴性患者年龄大（63.1±8.8 岁比 67.5±9.6 岁，=0.12）。两组间 CHADS-VASc 评分、梗死部位、微血管和大血管病变、颈动脉或主动脉斑块或卒中复发等其他参数无显著差异。
在 ESUS 患者中，早期植入 ILR 并进行 3 年心脏监测和远程传输，可检出 41.4%的 AF，并使其中 84%的患者接受了口服抗凝治疗。
