![]() ![]() ICMs were proven superior in terms of diagnostic detection efficacy, compared to standard monitoring in the CS setting. In a meta-analysis conducted by Burkowitz et al. Recently, the EMBRACE or CRYSTAL-AF studies have revealed the ICM’s diagnostic sensitivity to detect numerous arrhythmias, especially AF in CS patients, with detection rates nearing 25%. In the literature, CS is defined as a stroke without any identifiable cause, even after extensive workup. Hence, the detection of AF following a cryptogenic stroke (CS) is a key indication for an ICM. Nevertheless, as AF can be asymptomatic and discontinuous, this silent risk factor may easily evade detection. Although AF-related strokes are common and often associated with devastating consequences, they are largely preventable using anticoagulation therapy. The prevention of AF-related strokes is increasingly recognized as a global priority for public health. Implantable cardiac monitors (ICMs) are currently employed to detect, monitor, and record the heart rhythms of patients at risk of arrhythmia, including tachyarrhythmia, bradyarrhythmia, and atrial fibrillation (AF). An open discussion concerning optimal care forms and opportunities for introducing digitizing care pathways appears warranted. Further randomized studies are warranted to confirm these encouraging data. ![]() This study confirmed the feasibility of using an interdisciplinary and intersectoral therapeutic approach for monitoring CS patients with implanted ICMs. No statistically significant between-group differences were found with regard to integration into tele-monitoring, nor were there any differences identified between outpatient care at the UMR or in the outpatient sector. Comparing patients with and without stroke recurrence revealed that the median age in the stroke recurrence group tended to be higher by 14 years. Stroke recurrence was recorded in five patients, with a median observation time to the event of 9 months. Comparing patients with and without AF revealed that the median age of the AF group exceeded by 10 years that of the other patients. In all cases, AF detection was followed by immediate medical intervention. Within a median observation period of 21.5 months, AF occurred in 19 patients, with a median observation time to the event of 7 months. The indication for ICM implantation was made for 102 patients, 88 of whom underwent ICM implantation, with full documentation available for these 88 study patients. Outpatient care consisted of tele-monitoring of implants or interval-based follow-up care. Cardiologists programmed individual threshold values during ICM implantation, which were designed to instantly trigger an episode being recording and an alarm message being sent out. The ICM implantation was performed during the inpatient stay in the neurology department, with inclusion and exclusion criteria jointly determined by the neurology and cardiology departments. This study that involved patients with CS or transient ischemic attack (TIA), all of whom carried an implantable cardiac monitor (ICM), sought to assess the incidence of AF and other arrhythmia detected using tele-monitoring or interval-based follow-up by an internal cardiologist at the university medical center of Rostock (UMR) or an external cardiologist. Detection of atrial fibrillation (AF) after cryptogenic stroke (CS) has therapeutic implications, but the most effective type and optimal duration of monitoring have still to be defined. ![]()
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