Ultra-early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic stroke

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• dc.contributor.author Cuadrado-Godia, Elisa
• dc.contributor.author Benito Villabriga, Begoña
• dc.contributor.author Ois Santiago, Angel Javier
• dc.contributor.author Vallés Gras, Ermengol
• dc.contributor.author Rodríguez-Campello, Ana
• dc.contributor.author Giralt-Steinhauer, Eva
• dc.contributor.author Cabrera Gómez, Sandra
• dc.contributor.author Alcalde Rodríguez, Oscar
• dc.contributor.author Jiménez-López, Jesús
• dc.contributor.author Jiménez Conde, Jordi
• dc.contributor.author Martí-Almor, Julio
• dc.contributor.author Roquer, Jaume
• dc.date.accessioned 2020-01-13T08:24:13Z
• dc.date.issued 2010
• dc.description.abstract Background and purpose: Subclinical atrial fibrillation (AF) is known to underlie a number of cases of cryptogenic stroke (CrS). However, there is need to define the most effective strategy for AF detection. The diagnostic usefulness was analysed of a strategy based on ultra-early continuous monitoring in patients with CrS in terms of AF detection, oral anticoagulation treatment and stroke recurrence, in comparison to a standard outpatient strategy. Methods: Patients with ischaemic stroke of undetermined origin and confirmed to be cryptogenic after extensive work-up were searched for AF with (i) a conventional strategy (historical cohort, n = 101) with serial electrocardiograms and 24-h Holter monitoring or (ii) an ultra-early monitoring strategy with insertable cardiac monitor (ICM) implanted before discharge (prospective cohort, n = 90). AF episodes lasting >1 min, anticoagulant treatment and stroke recurrence were recorded. Results: During admission, AF was similarly detected in both cohorts (24% of patients). After discharge (mean follow-up 30 ± 10 months), AF detection rates were 17/80 (21.3%) and 38/65 (58.5%) for patients in the conventional versus the ultra-early ICM group (P < 0.001). Up to 41% of AF cases in the ICM cohort were detected within the first month. Oral anticoagulation was initiated in 37.6% versus 65.5% (P < 0.001) and stroke recurrence was recorded in 10.9% versus 3.3% (P 0.04) in the conventional versus the ICM cohort. Conclusions: Pre-discharge ICM implant allows detection of AF during follow-up in up to 58% of selected patients with CrS. Compared to a conventional strategy, ultra-early ICM implant results in higher anticoagulation rates and a decrease in stroke recurrence.
• dc.format.mimetype application/pdf
• dc.identifier.citation Cuadrado-Godia E, Benito B, Ois A, Vallès E, Rodríguez-Campello A, Giralt-Steinhauer E, et al. Ultra-early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic stroke. Eur J Neurol. 2020 Feb;27(2):244-250. DOI 10.1111/ene.14061
• dc.identifier.doi http://dx.doi.org/10.1111/ene.14061
• dc.identifier.issn 1351-5101
• dc.identifier.uri http://hdl.handle.net/10230/43260
• dc.language.iso eng
• dc.publisher Wiley
• dc.rights This is the peer reviewed version of the following article: Cuadrado-Godia E, Benito B, Ois A, Vallès E, Rodríguez-Campello A, Giralt-Steinhauer E, et al. Ultra-early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic stroke. Eur J Neurol. 2020 Feb;27(2):244-250, which has been published in final form at http://dx.doi.org/10.1111/ene.14061. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.subject.keyword Atrial fibrillation
• dc.subject.keyword Cardiac monitor
• dc.subject.keyword Cryptogenic stroke
• dc.subject.keyword Stroke recurrence
• dc.title Ultra-early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic stroke
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/acceptedVersion