Department of Arrhythmia Services, Department of Cardiology, Barts Heart Center, St Bartholomew's Hospital, W Smithfield, London EC1A7BE, UK.
Department of Arrhythmia Services, Department of Cardiology, Barts Heart Center, St Bartholomew's Hospital, W Smithfield, London EC1A7BE, UK.
J Stroke Cerebrovasc Dis. 2022 Jul;31(7):106474. doi: 10.1016/j.jstrokecerebrovasdis.2022.106474. Epub 2022 May 8.
Diagnosing atrial fibrillation (AF) in patients following Cryptogenic stroke (CS) has therapeutic implications that can reduce the risk of further strokes. However, it's indolent and paroxysmal nature makes this challenging. Prolonged rhythm monitoring using implantable loop recorders (ILRs) can significantly increase the AF detection rate in the clinical trial paradigm. Whether this can be translated to real-world practice is unknown. An evaluation of referral pathways, workload and real-world efficacy may help select patients and inform service development.
Retrospective review of all patients with CS referred to a tertiary electrophysiology referral hospital for ILR implantation between February 2017 and October 2020 for AF detection was conducted. The electronic health record was used to determine demographic and mortality data. Remote monitoring was used to identify AF occurrence.
107 patients were included. The average time from stroke to ILR implantation was 10.5 (5.9-18.6) months. The average monitoring duration was 18.1 ± 11.2 months with 15 (14.0%) patients diagnosed with AF and commenced on anticoagulation. One diagnosis were made in the first 30 days whereas 11 (73%) were made within 12 months. Paroxysmal AF episodes ranged from 6 min to 13 h. Patients with CHADS-VASc >3 were more likely to have AF (20.3% vs 4.7%, p = 0.02). Age was independently associated with AF detection after multi-variate regression. 352 ± 1171 unique events were recorded per patient, 75% of which were for suspected AF. External manufacturer-led triage of transmissions reduced transmission volume by 33%.
ILR-based AF detection rate was high among referred CS patients, despite implantation occurring relatively late. Older patients may be less likely to be referred despite positive correlation between age and AF detection. Although recording algorithms and external triage reduced transmission volume, specialist analysis was required to manage the ILR event burden.
诊断隐源性卒中（CS）后患者的心房颤动（AF）具有治疗意义，可以降低进一步发生中风的风险。然而，其隐匿性和阵发性特点使得这一诊断具有挑战性。使用植入式环路记录器（ILR）进行长时间的节律监测可显著提高临床试验中 AF 的检测率。但这种方法能否转化为实际应用尚不清楚。评估转诊途径、工作量和实际疗效可能有助于选择患者并为服务发展提供信息。
对 2017 年 2 月至 2020 年 10 月期间因 AF 检测而被转诊至三级电生理转诊医院植入 ILR 的所有 CS 患者进行回顾性分析。使用电子病历确定人口统计学和死亡率数据。远程监测用于识别 AF 发生情况。
共纳入 107 例患者。从卒中到 ILR 植入的平均时间为 10.5（5.9-18.6）个月。平均监测时间为 18.1±11.2 个月，其中 15 例（14.0%）患者被诊断为 AF 并开始抗凝治疗。首次 30 天内诊断出 1 例，12 个月内诊断出 11 例（73.0%）。阵发性 AF 发作时间从 6 分钟到 13 小时不等。CHADS-VASc＞3 的患者发生 AF 的可能性更高（20.3% vs. 4.7%，p=0.02）。多变量回归分析显示，年龄与 AF 检出独立相关。每位患者记录的独特事件为 352±1171 次，其中 75%为疑似 AF。外部制造商主导的传输分类可将传输量减少 33%。
尽管植入时间相对较晚，但在转诊的 CS 患者中，基于 ILR 的 AF 检测率仍然很高。尽管年龄与 AF 检出呈正相关，但年龄较大的患者可能不太愿意被转诊。尽管记录算法和外部分类可减少传输量，但仍需要专家分析来管理 ILR 事件负担。
