Cryptogenic stroke and underlying atrial fibrillation
Tommaso Sanna, Hans-Christoph Diener, Rod S Passman, Vincenzo Di Lazzaro, Richard A Bernstein, Carlos A Morillo, Marilyn Mollman Rymer, Vincent Thijs, Tyson Rogers, Frank Beckers, Kate Lindborg, Johannes Brachmann, CRYSTAL AF Investigators, Tommaso Sanna, Hans-Christoph Diener, Rod S Passman, Vincenzo Di Lazzaro, Richard A Bernstein, Carlos A Morillo, Marilyn Mollman Rymer, Johannes Brachmann, Scott Kasner, Michael Reiter, Nick Freemantle, Harold Adams, Salman Azhar, Adrian Pietersen, Helmut Puererfeller, Marten Rosenqvist, Adrian Pietersen, Helmut Puererfeller, Vincenzo Di Lazzaro, Tommaso Sanna, Johannes Brachmann, Rod Passman, Richard Bernstein, Carlos Morillo, Jaime Silva, Hans-Christoph Diener, Brian Ramza, Marilyn Rymer, Georgios Papaioannou, Igor Sibon, Vincent Thijs, Deiter Nuyens, Alfonso Brescia, Gennaro Miracapillo, Gernot Rudel, Michael Brainin, Manish Assar, Dion Graybeal, Franz Gruber, Clemens Steinwender, Keith Kyker, Justin Graff, Donald Rubenstein, John R Absher, Tobien Schreuder, Hans Kragten, Thomas Tu, Gregory Pittman, Pieter Hilkens, William Choe, Alessandro Locatelli, Fabrizio Fiacco, Kurt Niederkorn, Reginald Ho, Carissa Pineda, Carla Zat, Roberto Mureddu, Rolf Wachter, Dominique Blommaert, Lubos Urban, Gerian Grönefeld, Peter Paul Urban, Allan Nichols, Kristin Johnson, Cathy Bertrand, Fernando Pico, Sonia Alamowitch, James Daniels, Mark Johnson, Peter Goethals, Gaetano Paparella, John Harding, Abraham Ashkenazi, Dorte Damgaard, Christian Gerdes, Jean-Claude Deharo, Loïc Milandre, Ignacio Fernández Lozano, Peter Fung, Bing Liem, Patrick Cras, Chere Chase, Joachim Röther, Félix Alejandro Ayala Paredes, Sylvie Gosselin, Ramakota Reddy, Raymond N Englander, Alexander Khaw, Lubos Urban, Jane Chen, Andria Ford, Michael Jacoby, Helmut Keller, Risto Olavi Roine, Lucas Margolies, Anthonie Everardus Tuinenburg, Bart van der Worp, Gunjan Shukla, Mukesh Solanky, Branislav Stančák, Claus Schmitt, Georg Gahn, Stelios Tzeis, Pyotr Platonov, Arne Lindgren, Robert Andrew Pickett, Craig Woodard, Uwe Schlegel, Tommaso Sanna, Hans-Christoph Diener, Rod S Passman, Vincenzo Di Lazzaro, Richard A Bernstein, Carlos A Morillo, Marilyn Mollman Rymer, Vincent Thijs, Tyson Rogers, Frank Beckers, Kate Lindborg, Johannes Brachmann, CRYSTAL AF Investigators, Tommaso Sanna, Hans-Christoph Diener, Rod S Passman, Vincenzo Di Lazzaro, Richard A Bernstein, Carlos A Morillo, Marilyn Mollman Rymer, Johannes Brachmann, Scott Kasner, Michael Reiter, Nick Freemantle, Harold Adams, Salman Azhar, Adrian Pietersen, Helmut Puererfeller, Marten Rosenqvist, Adrian Pietersen, Helmut Puererfeller, Vincenzo Di Lazzaro, Tommaso Sanna, Johannes Brachmann, Rod Passman, Richard Bernstein, Carlos Morillo, Jaime Silva, Hans-Christoph Diener, Brian Ramza, Marilyn Rymer, Georgios Papaioannou, Igor Sibon, Vincent Thijs, Deiter Nuyens, Alfonso Brescia, Gennaro Miracapillo, Gernot Rudel, Michael Brainin, Manish Assar, Dion Graybeal, Franz Gruber, Clemens Steinwender, Keith Kyker, Justin Graff, Donald Rubenstein, John R Absher, Tobien Schreuder, Hans Kragten, Thomas Tu, Gregory Pittman, Pieter Hilkens, William Choe, Alessandro Locatelli, Fabrizio Fiacco, Kurt Niederkorn, Reginald Ho, Carissa Pineda, Carla Zat, Roberto Mureddu, Rolf Wachter, Dominique Blommaert, Lubos Urban, Gerian Grönefeld, Peter Paul Urban, Allan Nichols, Kristin Johnson, Cathy Bertrand, Fernando Pico, Sonia Alamowitch, James Daniels, Mark Johnson, Peter Goethals, Gaetano Paparella, John Harding, Abraham Ashkenazi, Dorte Damgaard, Christian Gerdes, Jean-Claude Deharo, Loïc Milandre, Ignacio Fernández Lozano, Peter Fung, Bing Liem, Patrick Cras, Chere Chase, Joachim Röther, Félix Alejandro Ayala Paredes, Sylvie Gosselin, Ramakota Reddy, Raymond N Englander, Alexander Khaw, Lubos Urban, Jane Chen, Andria Ford, Michael Jacoby, Helmut Keller, Risto Olavi Roine, Lucas Margolies, Anthonie Everardus Tuinenburg, Bart van der Worp, Gunjan Shukla, Mukesh Solanky, Branislav Stančák, Claus Schmitt, Georg Gahn, Stelios Tzeis, Pyotr Platonov, Arne Lindgren, Robert Andrew Pickett, Craig Woodard, Uwe Schlegel
Abstract
Background: Current guidelines recommend at least 24 hours of electrocardiographic (ECG) monitoring after an ischemic stroke to rule out atrial fibrillation. However, the most effective duration and type of monitoring have not been established, and the cause of ischemic stroke remains uncertain despite a complete diagnostic evaluation in 20 to 40% of cases (cryptogenic stroke). Detection of atrial fibrillation after cryptogenic stroke has therapeutic implications.
Methods: We conducted a randomized, controlled study of 441 patients to assess whether long-term monitoring with an insertable cardiac monitor (ICM) is more effective than conventional follow-up (control) for detecting atrial fibrillation in patients with cryptogenic stroke. Patients 40 years of age or older with no evidence of atrial fibrillation during at least 24 hours of ECG monitoring underwent randomization within 90 days after the index event. The primary end point was the time to first detection of atrial fibrillation (lasting >30 seconds) within 6 months. Among the secondary end points was the time to first detection of atrial fibrillation within 12 months. Data were analyzed according to the intention-to-treat principle.
Results: By 6 months, atrial fibrillation had been detected in 8.9% of patients in the ICM group (19 patients) versus 1.4% of patients in the control group (3 patients) (hazard ratio, 6.4; 95% confidence interval [CI], 1.9 to 21.7; P<0.001). By 12 months, atrial fibrillation had been detected in 12.4% of patients in the ICM group (29 patients) versus 2.0% of patients in the control group (4 patients) (hazard ratio, 7.3; 95% CI, 2.6 to 20.8; P<0.001).
Conclusions: ECG monitoring with an ICM was superior to conventional follow-up for detecting atrial fibrillation after cryptogenic stroke. (Funded by Medtronic; CRYSTAL AF ClinicalTrials.gov number, NCT00924638.).
Source: PubMed