Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany.
German Centre for Cardiovascular Research (DZHK), Partner Site: Munich Heart Alliance, Munich, Germany.
PLoS One. 2024 Apr 17;19(4):e0302404. doi: 10.1371/journal.pone.0302404. eCollection 2024.
Embolic stroke of undetermined source (ESUS) accounts for up to 20% of ischemic strokes annually. Undetected atrial fibrillation (AF) is one important potential underlying cause. For AF, oral anticoagulation has evolved as the most preferable means of secondary stroke prevention. To detect unrecognized paroxysmal AF, long-term ECG monitoring is required, and implantable cardiac monitors (ICM) appear most suitable. Yet, ICMs are particularly costly, implantation is invasive, and remote monitoring places a personnel burden on health care providers. Here, we use data from a large cohort of ESUS patients to systematically analyze the effort of ICM remote monitoring for AF diagnosis and the strain on health care providers.
From a prospective, single-center, observational ESUS registry, we analyzed all ICM-equipped patients post-ESUS (n = 172) between January 1st, 2018, and December 31st, 2019. Through January 2nd, 2023, 48 patients (27.9%) were diagnosed with AF by ICM remote monitoring. During follow-up, a total of 29,180 remote monitoring episodes were transmitted, of which 17,742 were alarms for AF. A systematic estimation of workload revealed that on average, 20.3 trained physician workhours are required to diagnose one patient with AF.
ICM remote monitoring is useful to diagnose AF in cohort of post-ESUS patients. However, the number of ICM alarms is high, even in a cohort at known high risk of AF and in whom AF detection is therapeutically consequential. Improved automated event classification, clear recommendations for ICM interrogation after AF diagnosis, and a careful patient selection for ICM monitoring are warranted.
不明来源栓塞性卒中（ESUS）占每年缺血性卒中的 20%。未检出的心房颤动（AF）是一个重要的潜在潜在原因。对于 AF，口服抗凝剂已成为二级卒中预防的首选方法。为了检测未被识别的阵发性 AF，需要进行长期心电图监测，而植入式心脏监测器（ICM）似乎最适合。然而，ICM 特别昂贵，植入是侵入性的，远程监测给医疗保健提供者带来了人员负担。在这里，我们使用来自 ESUS 患者大型队列的数据，系统地分析 ICM 远程监测在 AF 诊断中的作用以及对医疗保健提供者的影响。
我们从 2018 年 1 月 1 日至 2019 年 12 月 31 日期间对前瞻性、单中心、观察性 ESUS 登记处的所有 ICM 配备患者（n=172）进行了分析。截至 2023 年 1 月 2 日，通过 ICM 远程监测诊断了 48 例（27.9%）患者发生 AF。在随访期间，共传输了 29180 次远程监测事件，其中 17742 次为 AF 警报。对工作量进行系统估计表明，平均需要 20.3 名经过培训的医生工作小时才能诊断出 1 例 AF 患者。
ICM 远程监测可用于诊断 ESUS 后患者的 AF。然而，即使在 AF 检测具有治疗意义且已知 AF 风险较高的队列中，ICM 警报数量也很高。需要改进自动事件分类、明确 AF 诊断后的 ICM 检查建议，并仔细选择适合 ICM 监测的患者。
