Cardiology Research Department, East Sussex Hospitals NHS Trust, Eastbourne District General Hospital, Kings Drive, Eastbourne BN21 2UD, UK.
Cardiology Research Department, East Sussex Hospitals NHS Trust, Eastbourne District General Hospital, Kings Drive, Eastbourne BN21 2UD, UK.
J Stroke Cerebrovasc Dis. 2023 Mar;32(3):106988. doi: 10.1016/j.jstrokecerebrovasdis.2023.106988. Epub 2023 Jan 14.
Atrial fibrillation (AF) is suspected as the main cause of stroke in the majority of patients presenting with cryptogenic stroke (CS). Implantable loop recorders (ILR's) are indicated for detecting AF in these patients. The short term (<1 month) and long-term AF detection rates in patients inserted with an ILR immediately after CS is reported. Secondly, we compare the safety of nurse led vs physician led ILR implantation in these patients.
This is a retrospective review of all patients who underwent inpatient ILR implantation (Medtronic Linq) between May 2020 and May 2022 at East Sussex Healthcare NHS trust. All patients were remotely monitored via the FOCUSON monitoring and triage service.
A total of 186 subjects were included in the study and were followed up for a mean period of 363.0 +/- 222.6 days. The mean time between stroke and ILR was 7.0 +/- 5.5 days. The mean time between referral and ILR was 1.0 +/- 2.0 days. AF was detected in 25 (13.4%) patients. During the first 30 days of monitoring, AF was detected in 9 (4.8%) patients. The number of ILR implants performed by the specialist nurse was 107 (57.5%). There was no significant difference in the major complication rate (requiring device removal) between nurse and physician led implant (1 (0.95%) vs 0 (0%), p value = 0.389).
Inpatient ILR for cryptogenic stroke is feasible. The rate of AF detection in the first month post CS is 4.8% however, more AF was detected up to one year post implant, suggesting rationale for proceeding directly to ILR implant in these patients before discharge to not delay treatment. A nurse led service is also viable with no significant difference in the major complication rate compared to physician led implants.
在大多数表现为隐源性卒中（CS）的患者中，心房颤动（AF）被怀疑是卒中的主要原因。植入式环路记录器（ILR）适用于检测这些患者的 AF。报告了在 CS 后立即植入 ILR 的患者中短期（<1 个月）和长期 AF 检测率。其次，我们比较了在这些患者中由护士主导与医生主导的 ILR 植入的安全性。
这是对 2020 年 5 月至 2022 年 5 月期间在东萨塞克斯郡保健 NHS 信托基金住院接受 ILR 植入（美敦力 Linq）的所有患者进行的回顾性研究。所有患者均通过 FOCUSON 监测和分诊服务进行远程监测。
共纳入 186 例患者，平均随访 363.0+/-222.6 天。卒中与 ILR 之间的平均时间为 7.0+/-5.5 天。从转介到 ILR 的平均时间为 1.0+/-2.0 天。25 例（13.4%）患者检测到 AF。在监测的前 30 天内，9 例（4.8%）患者检测到 AF。由专科护士进行的 ILR 植入数量为 107 例（57.5%）。护士和医生主导植入的主要并发症发生率（需要移除设备）无显著差异（1（0.95%）比 0（0%），p 值=0.389）。
住院患者 CS 的 ILR 是可行的。CS 后第一个月 AF 的检出率为 4.8%，但植入后一年检出的 AF 更多，这表明在这些患者出院前直接进行 ILR 植入以不延迟治疗是合理的。护士主导的服务也是可行的，与医生主导的植入物相比，主要并发症发生率无显著差异。
