Uhe Tobias, Keilitz Janina, Berrouschot Jörg, Wachter Rolf
Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany.
Klinik für Neurologie, Klinikum Altenburger Land, Altenburg, Germany.
TH Open. 2024 Apr 17;8(2):e202-e208. doi: 10.1055/s-0044-1786015. eCollection 2024 Apr.
Continuous monitoring using implantable cardiac monitors (ICMs) results in atrial fibrillation (AF) detection rates of up to 30% in patients with cryptogenic stroke (CS). Although higher age is an independent risk factor for AF, there are no age-specific recommendations for the implantation of ICM. The aim of this study was to analyze age-related AF rates in patients with CS and continuous rhythm monitoring, to determine the rates of oral anticoagulation (OAC) and recurrent cerebrovascular events (stroke or transient ischemic attack) in patients with ICM-detected AF, and to describe the temporal relationship of AF detection and recurrent cerebrovascular events. In this observational study, patients with CS provided with ICMs were systematically followed. All patients underwent 72-hour electrocardiography monitoring, transcranial Doppler ultrasound, and transthoracic echocardiography prior to ICM insertion. Follow-up included a regular outpatient presentation every 3 months with medical history, physical examination, and interrogation of the ICM. One-hundred eighty-six patients (mean age: 65 ± 12 years, 54% female) were included in this analysis. AF was detected in 6, 27, 56, and 65% ( < 0.001) of patients aged less than 60, 60 to 69, 70 to 79, and more than or equal to 80 years, respectively. All patients with AF under 60 years had an impaired left ventricular systolic function. OAC was initiated in 85% of the patients with AF. Recurrent cerebrovascular events occurred in 34 patients of whom 14 had a diagnosis of AF. In nine patients, AF was diagnosed before the occurrence of a recurrent cerebrovascular event. AF prevalence increased with age and was absent in CS patients younger than 60 years and with preserved left ventricular ejection fraction. The temporal relationship of AF and recurrent cerebrovascular events was weak.
使用植入式心脏监测器（ICM）进行连续监测，在不明原因卒中（CS）患者中，心房颤动（AF）的检出率高达30%。尽管高龄是AF的独立危险因素，但对于ICM植入尚无针对特定年龄的建议。 本研究的目的是分析CS患者中与年龄相关的AF发生率、连续心律监测情况，确定ICM检测到AF的患者口服抗凝药（OAC）的使用率及复发性脑血管事件（卒中或短暂性脑缺血发作）的发生率，并描述AF检测与复发性脑血管事件之间的时间关系。 在这项观察性研究中，对配备ICM的CS患者进行了系统随访。所有患者在植入ICM前均接受了72小时心电图监测、经颅多普勒超声检查和经胸超声心动图检查。随访包括每3个月定期门诊就诊，记录病史、进行体格检查并询问ICM情况。 本分析纳入了186例患者（平均年龄：65±12岁，54%为女性）。年龄小于60岁、60至69岁、70至79岁以及80岁及以上的患者中，AF的检出率分别为6%、27%、56%和65%（P<0.001）。所有60岁以下发生AF的患者左心室收缩功能均受损。85%的AF患者开始使用OAC。34例患者发生了复发性脑血管事件，其中14例诊断为AF。9例患者在复发性脑血管事件发生前被诊断出AF。 AF患病率随年龄增加而升高，60岁以下且左心室射血分数正常的CS患者未出现AF。AF与复发性脑血管事件之间的时间关系较弱。
