Abstract 400 The role of implantable loop recorders and home monitoring after detection of atrial fibrillation in patients with cryptogenic stroke: Results from a prospective single-center database

Clin Res Cardiol (2021) DOI DOI https://doi.org/10.1007/s00392-021-01843-w
The role of implantable loop recorders and home monitoring after detection of atrial fibrillation in patients with cryptogenic stroke: Results from a prospective single-center database
Z. Arica¹, M. S. Arolt¹, S. Dittrich¹, S. C. R. Erlhöfer¹, K. Filipovic¹, C. Scheurlen¹, J. Terporten², J.-H. van den Bruck¹, J. Wörmann¹, A. Sultan¹, J. Lüker¹, D. Steven¹
¹Abteilung für Elektrophysiologie, Herzzentrum der Universität zu Köln, Köln; ²Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Köln;
Introduction Implantable loop recorders (ILR) and home monitoring systems are an effective tool to detect atrial fibrillation (AF) in patients (pts) with embolic stroke of undetermined source (ESUS). The benefit of continuous monitoring after detection of AF in pts with ESUS still remains unclear. The aim of this study was to evaluate the prevalence of treatment changing diagnosis using ILR and home monitoring in pts with ESUS after detection of AF and initiation of oral anticoagulation (OAC). Methods We prospectively included consecutive pts who received an ILR (Reveal LINQ, Medtronic; Confirm Rx, St. Jude Medical; Biomonitor III, Biotronik) after ESUS at the University Hospital Cologne between 01/2015 and 11/2020. Using home monitoring system, pt data were analyzed daily. Results A total of 68 pts (55.9±13.9 years, 75% male, mean CHA2DS2-VASc score 3.5±1.3) were included within 4.7±11.7 months after ESUS. In 29 pts treatment changing diagnosis was made based on ILR transmissions. AF was diagnosed in 17/29 pts (25% of all pts) after 11.6±10.1 months (in 47% of the pts within ≤6 months, in 53% within 12 months, in 88% within 24 months) and OAC was initiated. In 9/29 pts supraventricular tachycardia (SVT) was diagnosed after 10.8±8.0 months and 2/4 pts underwent catheter ablation (CA) for SVT. In 2/29 pts third-degree AV block was diagnosed after 13.0±18.4 months and 2/2 pts received dual chamber pacemakers. In 1/29 pt premature ventricular contractions were diagnosed after 44 months. Based on home monitoring findings after the diagnosis of AF in 3/17 pts SVT was diagnosed after 9.0±7.8 months and in 1/17 pts third-degree AV block was diagnosed after 13 months, who received a dual chamber pacemaker. Recurrent strokes were observed in 2/17 pts 6.5±2.1 months after the diagnosis of AF despite the initiation of OAC. Conclusion In this analysis of pts with ESUS, ILR with home monitoring yielded an AF detection rate of 25% within 11.6±10.1 months and a treatment changing diagnosis rate of 1% after 13 months after the detection of AF and is therefore in line with previous data from prospective randomized cohorts. The benefit and the time expenditure of home monitoring should be critically evaluated after the diagnosis of AF in pts with ESUS.
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