Insertable Cardiac Monitor More Effective at AF Detection than Standard Care

According to research presented at the International Stroke Conference 2023, continuous monitoring through an insertable cardiac monitor (ICM; Reveal LINQ; Medtronic, Dublin, Ireland) was more effective at detecting atrial fibrillation (AF) in individuals who had an index ischemic stroke than the standard of care. Previous study results revealed that over 1 year, the ICM detected AF in 12.1% of participants, while standard care detected AF in 1.8%. New study results show that over 3 years, the ICM identified significantly more AF than standard care (21.7% vs 2.4%). In this trial, 88% of AF incidents were asymptomatic.

Patients in the Stroke AF trial (NCT NCT02700945) were randomized 1:1 to the intervention cohort (n= 242) to have an ICM inserted within 10 days of index stroke or to the control group (n=250) to receive standard care through external cardiac monitoring, electrocardiograms, Holter monitoring, telemetry, or event recorders at the discretion of the physician. Both cohorts were followed for 3 years to investigate whether long-term continuous cardiac monitoring was more effective than standard care at identifying AF in patients with ischemic stroke from large-artery atherosclerosis or small-vessel occlusion. Patients were excluded if they had a cryptogenic stroke, cardioembolic stroke, previous AF, atrial flutter, embolic stroke with an unknown etiology, or contraindication for oral-anticoagulant therapy (OAC). Participants were enrolled between April 2016 and July 2019.

According to researchers: “The identification of AF in patients with stroke, whether it is the cause of the index stroke, unmasked by it, or coexistent, is, therefore, crucial for secondary stroke prevention with guideline-recommended OAC therapy.” ICM is particularly important because clients may be unable to report asymptomatic AF to their healthcare team.