Insertable cardiac monitors after cryptogenic stroke--a risk factor based approach to enhance the detection rate for paroxysmal atrial fibrillation.

Autor: Poli S; Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany., Diedler J; Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany., Härtig F; Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany., Götz N; Department of Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany., Bauer A; Department of Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany., Sachse T; Department of Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany., Müller K; Department of Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany., Müller I; Department of Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany., Stimpfle F; Department of Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany., Duckheim M; Department of Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany., Steeg M; Department of Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany., Eick C; Department of Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany., Schreieck J; Department of Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany., Gawaz M; Department of Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany., Ziemann U; Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany., Zuern CS; Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.; Department of Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany.
Jazyk: angličtina
Zdroj: European journal of neurology [Eur J Neurol] 2016 Feb; Vol. 23 (2), pp. 375-81. Date of Electronic Publication: 2015 Oct 16.
DOI: 10.1111/ene.12843
Abstrakt: Background and Purpose: Recently, the CRYSTAL AF trial detected paroxysmal atrial fibrillation (AF) in 12.4% of patients after cryptogenic ischaemic stroke (IS) or cryptogenic transient ischaemic attack (TIA) by an insertable cardiac monitor (ICM) within 1 year of monitoring. Our aim was (i) to assess if an AF risk factor based pre-selection of ICM candidates would enhance the rate of AF detection and (ii) to determine AF risk factors with significant predictive value for AF detection.
Methods: Seventy-five patients with cryptogenic IS/TIA were consecutively enrolled if at least one of the following AF risk factors was present: a CHA2DS2-VASc score ≥4, atrial runs, left atrium (LA) size >45 mm, left atrial appendage (LAA) flow ≤0.2 m/s, or spontaneous echo contrast in the LAA. The electrocardiographic and echocardiographic criteria were chosen as they have been repeatedly reported to predict AF; the same applies for four of the six items of the CHA2DS2-VASc score. The study end-point was the detection of one or more episodes of AF (≥2 min).
Results: Seventy-four patients underwent implantation of an ICM; one patient had AF at the date of implantation. After 6 months, AF was detected in 21/75 patients (28%), after 12 months in 25/75 patients (33.3%). 92% of AF episodes were asymptomatic. LA size >45 mm and the presence of atrial runs were independently associated with AF detection [hazard ratio 3.6 (95% confidence interval 1.6-8.4), P = 0.002, and 2.7 (1.2-6.7), P = 0.023, respectively].
Conclusions: The detection rate of AF is one-third after 1 year if candidates for an ICM after cryptogenic IS/TIA are selected by AF risk factors. LA dilation and atrial runs independently predict AF.
(© 2015 EAN.)
Databáze: MEDLINE
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