Insertable cardiac monitors effective for AF detection in cryptogenic stroke

Insertable cardiac monitors (ICMs) demonstrated to be an effective tool for the identification of atrial fibrillation (AF) in patients who experienced a cryptogenic stroke or cryptogenic transient ischaemic attack (TIA) in the NOR-FIB trial. The early start-up of ICMs was accessible to and manageable for clinicians.

For the prevention of secondary stroke, detection of the underlying cause is crucial. Prolonged cardiac rhythm monitoring and ≥72 hours of ECG monitoring are guideline-recommended for ruling out underlying AF in patients who experienced a cryptogenic stroke since 2014 and 2020, respectively. However, ICMs are still not implemented in stroke guidelines as the preferred option to perform this task. The NOR-FIB trial (NCT02937077) was designed to identify AF and quantify AF burden in patients who had had a cryptogenic stroke or cryptogenic TIA and were under continuous monitoring of an ICM for a year [1]. Included were 259 patients from 18 Scandinavian centres. Patients in whom AF episodes ≥2 minutes were registered, received a recommendation for oral anticoagulant treatment. Dr Barbara Ratajczak-Tretel (University of Oslo, Norway) presented the results.

After 12 months, AF was identified in 29% of the patients. Most (87%) of the detected AF cases at 12 months were already detected at 6 months after ICM insertion. Associated with the occurrence of AF were a higher age (P<0.001), an elevated pre-stroke CHA₂DS₂-VASc score (P<0.001), and an increased National Institutes of Health Stroke Scale (NIHSS) score (P=0.002). AF was also associated with hypertension and dyslipidaemia in the study population. Participants with detected AF were asymptomatic in 93% of the cases and 92% of the identified AF cases displayed recurrence of AF. Moreover, stroke recurrence was observed in 3% of the patients with AF and in 5% of the patients in whom AF was not detected.

According to Dr Ratajczak-Tretel, the NOR-FIB trial demonstrated that ICM was an effective tool for detecting underlying AF in patients who experienced a cryptogenic stroke or cryptogenic TIA. “Importantly, the use of ICMs was manageable for the attending neurologists or stroke physicians. Therefore, the use of ICMs appears feasible to be implemented in the assessment of patients who experienced a cryptogenic stroke or TIA.”

1. Ratajczak-Tretel B, et al. Atrial fibrillation in cryptogenic stroke and TIA patients in the Nordic atrial fibrillation and stroke (NOR-FIB) study: Topline results. What is new on stroke prevention, EHRA 2022, 3–5 April, Copenhagen, Denmark.

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Posted on 1 June, 202213 June, 2022