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CC BY 4.0 · TH Open 2024; 08(02): e202-e208
DOI: 10.1055/s-0044-1786015
Original Article

Age-Dependent Detection of Atrial Fibrillation with Implantable Cardiac Monitors in Patients with Cryptogenic Stroke

Tobias Uhe 
1   Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
,
Janina Keilitz
2   Klinik für Neurologie, Klinikum Altenburger Land, Altenburg, Germany
,
Jörg Berrouschot
2   Klinik für Neurologie, Klinikum Altenburger Land, Altenburg, Germany
,
Rolf Wachter
1   Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
› Author Affiliations Funding None.
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Abstract

Background Continuous monitoring using implantable cardiac monitors (ICMs) results in atrial fibrillation (AF) detection rates of up to 30% in patients with cryptogenic stroke (CS). Although higher age is an independent risk factor for AF, there are no age-specific recommendations for the implantation of ICM.

Objective The aim of this study was to analyze age-related AF rates in patients with CS and continuous rhythm monitoring, to determine the rates of oral anticoagulation (OAC) and recurrent cerebrovascular events (stroke or transient ischemic attack) in patients with ICM-detected AF, and to describe the temporal relationship of AF detection and recurrent cerebrovascular events.

Methods In this observational study, patients with CS provided with ICMs were systematically followed. All patients underwent 72-hour electrocardiography monitoring, transcranial Doppler ultrasound, and transthoracic echocardiography prior to ICM insertion. Follow-up included a regular outpatient presentation every 3 months with medical history, physical examination, and interrogation of the ICM.

Results One-hundred eighty-six patients (mean age: 65 ± 12 years, 54% female) were included in this analysis. AF was detected in 6, 27, 56, and 65% (p < 0.001) of patients aged less than 60, 60 to 69, 70 to 79, and more than or equal to 80 years, respectively. All patients with AF under 60 years had an impaired left ventricular systolic function. OAC was initiated in 85% of the patients with AF. Recurrent cerebrovascular events occurred in 34 patients of whom 14 had a diagnosis of AF. In nine patients, AF was diagnosed before the occurrence of a recurrent cerebrovascular event.

Conclusion AF prevalence increased with age and was absent in CS patients younger than 60 years and with preserved left ventricular ejection fraction. The temporal relationship of AF and recurrent cerebrovascular events was weak.

Keywords

implantable cardiac monitors - cryptogenic stroke - atrial fibrillation

Data Availability Statement

Data supporting this study are available on request.




Publication History

Received: 18 January 2024

Accepted: 11 March 2024

Article published online:
17 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
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