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

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 monitor...

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Autores: Cuadrado-Godia, Elisa, Benito Villabriga, Begoña, Ois Santiago, Angel Javier, Vallés Gras, Ermengol, Rodríguez-Campello, Ana, Giralt-Steinhauer, Eva, Cabrera Gómez, Sandra, Alcalde Rodríguez, Oscar, Jiménez-López, Jesús, Jiménez Conde, Jordi, Martí-Almor, Julio, Roquer, Jaume
Tipo de recurso: artículo
Estado:Versión aceptada para publicación
Fecha de publicación:2010
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:10230/43260
Acceso en línea:http://hdl.handle.net/10230/43260
http://dx.doi.org/10.1111/ene.14061
Access Level:acceso abierto
Palabra clave:Atrial fibrillation
Cardiac monitor
Cryptogenic stroke
Stroke recurrence
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spelling Ultra-early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic strokeCuadrado-Godia, ElisaBenito Villabriga, BegoñaOis Santiago, Angel JavierVallés Gras, ErmengolRodríguez-Campello, AnaGiralt-Steinhauer, EvaCabrera Gómez, SandraAlcalde Rodríguez, OscarJiménez-López, JesúsJiménez Conde, JordiMartí-Almor, JulioRoquer, JaumeAtrial fibrillationCardiac monitorCryptogenic strokeStroke recurrenceBackground 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.Wiley20202010info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/43260http://dx.doi.org/10.1111/ene.14061reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésThis 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.info:eu-repo/semantics/openAccessoai:recercat.cat:10230/432602026-05-29T05:05:01Z
dc.title.none.fl_str_mv Ultra-early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic stroke
title Ultra-early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic stroke
spellingShingle Ultra-early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic stroke
Cuadrado-Godia, Elisa
Atrial fibrillation
Cardiac monitor
Cryptogenic stroke
Stroke recurrence
title_short Ultra-early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic stroke
title_full Ultra-early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic stroke
title_fullStr Ultra-early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic stroke
title_full_unstemmed Ultra-early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic stroke
title_sort Ultra-early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic stroke
dc.creator.none.fl_str_mv Cuadrado-Godia, Elisa
Benito Villabriga, Begoña
Ois Santiago, Angel Javier
Vallés Gras, Ermengol
Rodríguez-Campello, Ana
Giralt-Steinhauer, Eva
Cabrera Gómez, Sandra
Alcalde Rodríguez, Oscar
Jiménez-López, Jesús
Jiménez Conde, Jordi
Martí-Almor, Julio
Roquer, Jaume
author Cuadrado-Godia, Elisa
author_facet Cuadrado-Godia, Elisa
Benito Villabriga, Begoña
Ois Santiago, Angel Javier
Vallés Gras, Ermengol
Rodríguez-Campello, Ana
Giralt-Steinhauer, Eva
Cabrera Gómez, Sandra
Alcalde Rodríguez, Oscar
Jiménez-López, Jesús
Jiménez Conde, Jordi
Martí-Almor, Julio
Roquer, Jaume
author_role author
author2 Benito Villabriga, Begoña
Ois Santiago, Angel Javier
Vallés Gras, Ermengol
Rodríguez-Campello, Ana
Giralt-Steinhauer, Eva
Cabrera Gómez, Sandra
Alcalde Rodríguez, Oscar
Jiménez-López, Jesús
Jiménez Conde, Jordi
Martí-Almor, Julio
Roquer, Jaume
author2_role author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Atrial fibrillation
Cardiac monitor
Cryptogenic stroke
Stroke recurrence
topic Atrial fibrillation
Cardiac monitor
Cryptogenic stroke
Stroke recurrence
description 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.
publishDate 2010
dc.date.none.fl_str_mv 2010
2020
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/acceptedVersion
format article
status_str acceptedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/43260
http://dx.doi.org/10.1111/ene.14061
url http://hdl.handle.net/10230/43260
http://dx.doi.org/10.1111/ene.14061
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Wiley
publisher.none.fl_str_mv Wiley
dc.source.none.fl_str_mv reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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