EXPEDIENT DETECTION OF PAROXYSMAL ATRIAL FIBRILLATION WITH PROLONGED EARLY MONITORING POST CRYPTOGENIC ISCHEMIC CEREBROVASCULAR EVENT
CCC ePoster Gallery. Kus T. 10/26/19; 280517; 282
Dr. Teresa Kus
Dr. Teresa Kus
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Abstract
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BACKGROUND: Expedient detection of atrial fibrillation (AF), the prime suspect in cryptogenic cerebrovascular events (CVE), is required to justify rapid initiation of anticoagulant therapy. Admission ECG and 24-hour Holter remain the usual approach in many centers. Subsequent monitoring is then left to the discretion of the treating physician. We sought to determine whether prolonged (up to 6 weeks) monitoring initiated within one week of the cryptogenic CVE would more quickly detect AF.

METHODS AND RESULTS: 124 subjects (63F:61M, age 73 ± 11 years, CHA2DS2-VASc 5.5 ±1.4) were recruited between January 2016 and December 2018 within one week of a cryptogenic CVE when ECG and 24-hour Holter were negative. After informed consent, they were randomized to an intensive group (Group I), received an event detector (SpiderFlash, Sorin) for 21 days, following which if negative, were offered another 21 days of monitoring within 3 months of the index CVE, or to standard follow-up (Group S) with the treating physician choosing further testing. Patients were contacted at 3 months to determine AF documentation. In Group I, 62 subjects were monitored initially (SpiderFlash, Sorin) for 18.0 ±5.6 days. A second monitoring (18.9± 4.8 days) was accepted by 22 subjects (35 %). In Group S, the treating physician prescribed a 7-day Holter (CardioStat, Icentia) in 14 of 62 subjects when available (third year of the recruitment period). In Group 1, AF (minimum 30 seconds) was documented in 6 subjects within 16 ± 11 days of the index CVE (5-60 days). In 5, AF occurred during the first monitoring with 2 detections between the 18th and 21st recording day; in the 6th subject on the 20th day of the 2nd period. In Group S, AF was detected by ECG in 2 subjects (32 and 61 days); in the 14 subjects with a 7-day Holter, there were 2 detections of AF at 5 and 11 days respectively post index CVE. There was significant delay between AF detection and the report provided upon analysis of the entire recording (24 ± 11 days post detection in Group I and 17-20 days post detection in the 2 patients of Group S).

CONCLUSION: Paroxysmal AF can be detected in about 10 % of cryptogenic CVE by early recording of 3 weeks duration and should be considered as first line investigation instead of the 24-hour Holter. Improvement in technology such that an alert is sent to the treating physician immediately on AF detection would expedite anticoagulant initiation.
BACKGROUND: Expedient detection of atrial fibrillation (AF), the prime suspect in cryptogenic cerebrovascular events (CVE), is required to justify rapid initiation of anticoagulant therapy. Admission ECG and 24-hour Holter remain the usual approach in many centers. Subsequent monitoring is then left to the discretion of the treating physician. We sought to determine whether prolonged (up to 6 weeks) monitoring initiated within one week of the cryptogenic CVE would more quickly detect AF.

METHODS AND RESULTS: 124 subjects (63F:61M, age 73 ± 11 years, CHA2DS2-VASc 5.5 ±1.4) were recruited between January 2016 and December 2018 within one week of a cryptogenic CVE when ECG and 24-hour Holter were negative. After informed consent, they were randomized to an intensive group (Group I), received an event detector (SpiderFlash, Sorin) for 21 days, following which if negative, were offered another 21 days of monitoring within 3 months of the index CVE, or to standard follow-up (Group S) with the treating physician choosing further testing. Patients were contacted at 3 months to determine AF documentation. In Group I, 62 subjects were monitored initially (SpiderFlash, Sorin) for 18.0 ±5.6 days. A second monitoring (18.9± 4.8 days) was accepted by 22 subjects (35 %). In Group S, the treating physician prescribed a 7-day Holter (CardioStat, Icentia) in 14 of 62 subjects when available (third year of the recruitment period). In Group 1, AF (minimum 30 seconds) was documented in 6 subjects within 16 ± 11 days of the index CVE (5-60 days). In 5, AF occurred during the first monitoring with 2 detections between the 18th and 21st recording day; in the 6th subject on the 20th day of the 2nd period. In Group S, AF was detected by ECG in 2 subjects (32 and 61 days); in the 14 subjects with a 7-day Holter, there were 2 detections of AF at 5 and 11 days respectively post index CVE. There was significant delay between AF detection and the report provided upon analysis of the entire recording (24 ± 11 days post detection in Group I and 17-20 days post detection in the 2 patients of Group S).

CONCLUSION: Paroxysmal AF can be detected in about 10 % of cryptogenic CVE by early recording of 3 weeks duration and should be considered as first line investigation instead of the 24-hour Holter. Improvement in technology such that an alert is sent to the treating physician immediately on AF detection would expedite anticoagulant initiation.
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