Anirban Das

Cryptogenic stroke is a stroke for which no reason is diagnosed after well-known diagnostic tests. Long-term implantable cardiac monitors can be better at diagnosing atrial fibrillation and offer a possibility to lessen the hazard of stroke recurrence with anticoagulants. In patients with a recent ischemic stroke, do 12 months of implantable loop recorder monitoring detect extra occurrences of atrial fibrillation (AF) as compared with conventional external loop recorder monitoring for 30 days A total of 300 patients, who currently experienced ischemic stroke withinside the absence of documented AF, had been randomly assigned 1:1 to prolonged electrocardiographic (ECG) monitoring with either an implantable loop recorder (n = 150) or an external loop recorder (n = 150) with follow-up visits at 30 days, 6 months, and 12 months.

Among the 300 sufferers who had been randomized (median age, 64 years; 40% were women), 66.3% had a stroke of undetermined etiology with an average CHA2DS2-Vasc score of 4). AF on monitoring at some stage in follow-up was observed in 15.3% of patients in the implantable loop recorder group and 4.7% of sufferers in the external loop recorder group (risk ratio, 3.29; p = 0.003). Five sufferers (3.3%) in the implantable loop recorder group had a recurrent ischemic stroke as opposed to 8 patients (5.3%) withinside the external loop recorder group. The prevalence of intracerebral hemorrhage was the same in each group (2%). Among patients with ischemic stroke and no prior proof of AF, implantable ECG monitoring for 12 months, as compared with prolonged external monitoring for 30 days, led to a considerably greater percentage of patients with AF detected over 12 months.

The detection of AF after ischemic stroke may be very important diagnostically because it has been proven that there's a risk reduction of recurrent stroke amongst patients with AF who're beginning to start on oral anticoagulation. Prior research evaluating ambulatory monitoring for detection of AF post-stroke had been confined to patients in whom stroke changed into cryptogenic after a thorough workup failed to reveal any potential reasons of stroke which include large-vessel or small-vessel disease, etc. The present study is more clinically applicable as it enrolled all stroke patients, as long as they did not have known AF, and it changed into the first head-to-head study looking at the detection rates of a 30-day external loop recorder as opposed to an implantable loop recorder analyzed at 12 months.