Utility and limitations of long-term monitoring of atrial fibrillation using an implantable loop recorder

Heart Rhythm ◽  
2018 ◽  
Vol 15 (2) ◽  
pp. 287-295 ◽  
Author(s):  
Randall Lee ◽  
Suneet Mittal
Keyword(s):  
Atrial Fibrillation ◽  
Implantable Loop Recorder ◽  
Loop Recorder ◽  
Long Term Monitoring ◽  
Term Monitoring

Abstract 209: Final Results of the Surprise Study:Long-term Monitoring For Atrial Fibrillation (AF) in Cryptogenic Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Louisa M Christensen ◽  
Derk Krieger ◽  
Søren Højberg ◽  
Ole D Pedersen ◽  
Finn M Karlsen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Final Analysis ◽  
Stroke Onset ◽  
Minor Stroke ◽  
Loop Recorder ◽  
Kaplan Meier ◽  
Long Term Monitoring ◽  
Term Monitoring

Background The true frequency of AF in patients with cryptogenic stroke or TIA is not well defined. The aim was to estimate the frequency and burden of AF in patients with apparent cryptogenic minor stroke or TIA by long term monitoring providing complete data on arrhythmia occurrence. Methods Patients with minor stroke or DWI-positive TIA were included if stroke causation remained unknown during standardized work up including 24 hours telemetry. A Reveal XT®, an atrial fibrillation sensitive loop-recorder, was implanted subcutaneously allowing continuous monitoring for up to 3 years. Arrhythmia episodes were adjudicated by senior consultant cardiologist. Endpoints include episodes of AF, time and burden of AF. A total of 84 patients were included and had a minimum of three months of monitoring before final analysis. Five patients were explanted due to local infections or discomfort. (fig.2) Results In 13 patients (15.5 %) AF was documented by long term monitoring. The mean burden of AF was 2 hours pr day monitored, varying from less than a minute to 17 hours pr day monitored. (median 20 minutes pr day monitored) Kaplan Meier (fig.1) presents time from stroke onset to first AF event, mean time was 106,0 days (SD 47,9 days) Time from stroke onset to implantation was at a median of 56 days. (Mean 80 days, SD 74,9). Logistic regression analysis including all elements of CHADS2VAS found increasing risk of AF with an OR = 1.096 (p=0.015) with increasing age in years. CHADS 2 VAS score was 4.14 in the AF group vs. 3.24 (p=0.03). Conclusion Paroxysmal AF is frequent and brief in patients with cryptogenic stroke. Long term monitoring resulted in change of treatment in one out of 6 patients in this cohort.

First clinical experience with the wearable cardiac rhythm long-term monitoring cardioskin device

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Guedeney ◽  
J Silvain ◽  
F Hidden-Lucet ◽  
C Maupain ◽  
S Dinanian ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Cardiac Rhythm ◽  
Cardiac Monitoring ◽  
Funding Source ◽  
Single Center ◽  
Long Term Monitoring ◽  
Monitoring Devices ◽  
Term Monitoring

Abstract Background There are only limited options for long-term cardiac monitoring devices readily available in clinical practice for outpatients. Holter monitoring devices are limited by the uncomfort of wires and patches, the small number of leads for analysis, the quality of recordings or the monitoring duration while insertable cardiac monitors are costly and exposed to potential local complication. Purpose To describe a single center experience with a novel wearable device for cardiac rhythm monitoring. Methods The Cardioskin™ system is a patch-free, wire-free, wearable device with rechargeable batteries that provides a high quality 15-lead electrocardiogram monitoring over 1 month (Figure 1). Data are sent using a mobile application downloaded in the patient smartphone to a central Corelab where they can be interpreted by an expert and/or the prescribing physician. An alarm signal is readily available within the Cardioskin™ device, to allow patients to indicate the presence of symptoms. In this single center retrospective registry, we provide a first report of the use of this novel device in real world practice, with indication and duration of cardiac monitoring left at the physicans “discretion”. Results From January 2019 to December 2019, the Cardioskin™ system was prescribed in 60 patients for an overall median duration of 26.5 (14–32) days. The mean age of the patients was 45±12.2 years and 24 (40%) were male. Indications for cardiac monitoring were post-Stroke, palpitation, syncope and cardiomyopathy assessment in 56%, 30%, 7% and 7% of the cases, respectively. A sustained (>30 seconds) supraventricular tachycardia was detected in 4 cases, including one case of atrial fibrillation, two case of atrial tachycardia and on case of junctional tachycardia. Unsustained ventricular tachycardia and atrial fibrillation burst were detected in another 2 cases (Figure 1). There was no reported case of skin irritation by the Cardioskin™ system or abrupt interruption of the monitoring by the patients. Conclusion The Cardioskin™ system is a novel, discreet and comfortable cardiac rhythm wearable long-term monitoring device which can be used in clinical practice for broad diagnostic indications. Figure 1. Cardioskin system Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): ACTION coeur

scholarly journals Incidence and Predictors of Very Late Recurrence of Atrial Fibrillation Following Cryoballoon Pulmonary Vein Isolation

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Dan L. Musat ◽  
Nicolle S. Milstein ◽  
Advay Bhatt ◽  
Tina C. Sichrovsky ◽  
Mark W. Preminger ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Late Recurrence ◽  
Implantable Loop Recorder ◽  
Ecg Monitoring ◽  
Loop Recorder ◽  
Risk Patients ◽  
First Recurrence

Background: A very late recurrence (VLR) of atrial fibrillation (AF) is considered present when the first recurrence of AF occurs ≥12 months following ablation. Prior studies characterizing VLR have not used an implantable loop recorder for ECG monitoring. Thus, it is unknown whether VLR truly occurs or whether these patients have simply had unrecognized AF. Our objective was to assess the incidence and predictors of VLR in patients who underwent cryoballoon pulmonary vein isolation alone, had an implantable loop recorder, and were confirmed AF free for at least 1 year. Methods: We enrolled consecutive patients with paroxysmal or persistent AF who underwent cryoballoon pulmonary vein isolation and had an implantable loop recorder implanted <3 months post-ablation. Patients free of AF 1 year post-ablation were followed prospectively for recurrent AF. All AF episodes were adjudicated. Results: We included 188 patients (66±10 years; 116 [62%] men; 102 [54%] paroxysmal AF; CHA 2 DS 2 -VASc, 2.6±1.7). After 1 year post-pulmonary vein isolation, 93 (49%) patients remained AF free. During subsequent follow-up, 30 (32%) patients had VLR of AF. The only independent risk factor for VLR was an elevated CHA 2 DS 2 -VASc score (hazard ratio, 1.317 [95% CI, 1.033–1.6979]; P =0.026). Patients with CHA 2 DS 2 -VASc score ≥4 represented a quarter of the population and were at the highest risk. Conclusions: Our data using implantable loop recorders for continuous ECG monitoring post-AF ablation show that VLR occurs in a third of patients after an apparently successful cryoballoon pulmonary vein isolation procedure. Additional strategies are needed to ensure long-term freedom from AF recurrences in these high-risk patients.

Sign in / Sign up

Export Citation Format

Share Document