Pikija Slaven, Rösler Cornelia, Leitner Ursula, Zellner Thomas, Bubel Nele, Ganser Bernhard, Hecker Constantin, Mutzenbach Johannes Sebastian
Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
Front Neurol. 2022 Jan 28;12:816511. doi: 10.3389/fneur.2021.816511. eCollection 2021.
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.
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.
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, = 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.
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.
在完成中风检查后，约三分之一的患者无法确定病因，其中不明来源栓塞性中风（ESUS）约占这些隐源性病因的50%。对于通过神经科医生启动和管理复杂的长期监测以检测疑似房颤（AFib）的情况，尚未进行充分研究。
我们招募了2016年1月至2020年7月间经神经科判定后接受Reveal LINQ环式记录仪植入的所有连续性ESUS患者。我们收集了人口统计学、临床、心脏和神经影像学、实验室以及在延长的基线心电图监测中评估的心电图数据、室上性（SVE）和室性（VE）期前收缩复合体数量以及植入前心电图PQ间期的数据。AFib检测由人工监督，持续时间超过120秒时判定为阳性。
我们共随访了131例患者，中位随访时间为504天。有45例（34%）经人工验证为AFib诊断。在单因素分析中，ESUS后更早植入与AFib检测相关（13天对31天，P = 0.011）。在多因素分析中，AFib发生率增加与植入前心电图测量的PQ间期延长（每增加50毫秒）（HR 1.99，95%CI 1.39 - 2.85）和SVE数量（HR 1.29，95%CI 1.05 - 1.57）相关。
我们观察到ESUS后AFib的预测因素相似，尽管频率高于先前报道。本研究表明，由神经科医生主导ESUS后植入式循环记录仪（ILR）的决策、管理和评估是可行的。
