Andrea Ungar1, Francesca Pescini2, Martina Rafanelli3, Maria Vittoria De Angelis4, Massimiliano Faustino5, Caterina Tomaselli6, Alfredo Petrone7, Giovanni Forleo8, Giovanni Morani9, Stefano Forlivesi10, Giulio Molon11, Alessandro Adami12, Massimiliano Maines13, Chiara Stegagno14, Anna Poggesi15, Leonardo Pantoni16. 1. Division of Geriatric and Intensive Care Medicine, Syncope Unit, University of Florence, Firenze, Italy. Electronic address: andrea.ungar@unifi.it. 2. Stroke Unit Emergency Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy. 3. Division of Geriatric and Intensive Care Medicine, Syncope Unit, University of Florence, Firenze, Italy. 4. Neurology Department, SS. Annunziata Hospital, Chieti, Italy. 5. Aritmology Department, SS. Annunziata Hospital, Chieti, Italy. 6. Cardiology Department, Annunziata Hospital, Cosenza, Italy. 7. Neurology Department, Annunziata Hospital, Cosenza, Italy. 8. Cardiology Unit, Luigi Sacco Hospital, Milan, Italy. 9. Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy. 10. Neurology and Stroke Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 11. Cardiology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy. 12. Stroke Center, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy. 13. Cardiology Department, S. Maria del Carmine Hospital, Rovereto, Italy. 14. Neurology Department, S. Maria del Carmine Hospital, Rovereto, Italy. 15. Stroke Unit Emergency Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy; IRCCS Fondazione Don Carlo Gnocchi, Firenze, Italy; NEUROFARBA Department, University of Florence, Firenze, Italy. 16. "Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milano, Italy. Electronic address: leonardo.pantoni@unimi.it.
Abstract
BACKGROUND: Implantable cardiac monitor (ICM) revealed subclinical atrial fibrillation (SCAF) in up to 30% of cryptogenic stroke (CS) patients in randomized trials. However, real world data are limited. OBJECTIVES: We investigated SCAF occurrence, treatments, clinical outcomes and predictors of SCAF in a multicenter real-world population subjected to ICM after CS. METHODS: From September 2016 to November 2019, 20 Italian centers collected data of consecutive patients receiving ICM after CS and followed with remote and outpatient follow-up according to clinical practice. All device-detected AF events were confirmed by the cardiologist to diagnose SCAF. RESULTS: ICM was implanted in 334 CS patients (mean age±SD 67.4±11.5 years, 129 (38.6%) females, 242 (76.1%) with CHA2DS2-VASC score≥4). During a follow-up of 23.6 (IQR 14.6-31.5) months, SCAF was diagnosed in 92 (27.5%) patients. First episode was asymptomatic in 81 (88.1%). SCAF daily burden ≥5 minutes was 22.0%, 24.1% and 31.5% at 6, 12, and 24 months after ICM implantation. Median time to first day with AF was 60 (IQR 18-140) days. Female gender, age>69 years, PR interval>160 ms and cortical-subcortical infarct type at enrolment were independently associated with an increased risk of SCAF. CONCLUSIONS: In a real-world population, ICM detected SCAF in more than a quarter of CS patients. This experience confirms the relevance of implanting CS patients, for maximizing the possibilities to detect AF, following failure of Holter monitoring, according to guidelines. However, there is need to demonstrate that shift to oral anticoagulation following SCAF detection is associated with reduced risk of recurrent stroke.
BACKGROUND: Implantable cardiac monitor (ICM) revealed subclinical atrial fibrillation (SCAF) in up to 30% of cryptogenic stroke (CS) patients in randomized trials. However, real world data are limited. OBJECTIVES: We investigated SCAF occurrence, treatments, clinical outcomes and predictors of SCAF in a multicenter real-world population subjected to ICM after CS. METHODS: From September 2016 to November 2019, 20 Italian centers collected data of consecutive patients receiving ICM after CS and followed with remote and outpatient follow-up according to clinical practice. All device-detected AF events were confirmed by the cardiologist to diagnose SCAF. RESULTS: ICM was implanted in 334 CSpatients (mean age±SD 67.4±11.5 years, 129 (38.6%) females, 242 (76.1%) with CHA2DS2-VASC score≥4). During a follow-up of 23.6 (IQR 14.6-31.5) months, SCAF was diagnosed in 92 (27.5%) patients. First episode was asymptomatic in 81 (88.1%). SCAF daily burden ≥5 minutes was 22.0%, 24.1% and 31.5% at 6, 12, and 24 months after ICM implantation. Median time to first day with AF was 60 (IQR 18-140) days. Female gender, age>69 years, PR interval>160 ms and cortical-subcortical infarct type at enrolment were independently associated with an increased risk of SCAF. CONCLUSIONS: In a real-world population, ICM detected SCAF in more than a quarter of CSpatients. This experience confirms the relevance of implanting CSpatients, for maximizing the possibilities to detect AF, following failure of Holter monitoring, according to guidelines. However, there is need to demonstrate that shift to oral anticoagulation following SCAF detection is associated with reduced risk of recurrent stroke.
Authors: Marta Rubiera; Ana Aires; Kateryna Antonenko; Sabrina Lémeret; Christian H Nolte; Jukka Putaala; Renate B Schnabel; Anil M Tuladhar; David J Werring; Dena Zeraatkar; Maurizio Paciaroni Journal: Eur Stroke J Date: 2022-06-03
Authors: Francesco Mele; Giuseppe Scopelliti; Arianna Manini; Carola Ferrari Aggradi; Matteo Baiardo; Marco Schiavone; Maurizio Viecca; Andrea Ianniello; Pierluigi Bertora; Giovanni B Forleo; Leonardo Pantoni Journal: J Neurol Date: 2022-09-13 Impact factor: 6.682