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Implantable recorders identify AF in cryptogenic stroke

Insertable cardiac monitor (ICM) implantation for the detection of intermittent atrial fibrillation (iAF) during outpatient follow-up is feasible in patients with cryptogenic stroke, according to a study1 published recently in Stroke. ICMs offer a much higher diagnostic yield than 7-day Holter monitoring, the authors also found.

A significant number of patients with cryptogenic stroke suffer from iAF which was not detected during the standard diagnostic procedures. Researchers investigated whether implantation of an ICM is feasible in patients with cryptogenic stroke, and compared the iAF detection rate of the ICM with 7-day Holter monitoring.

60 patients (median age 63; interquartile range, 48.5–72 years) with acute cryptogenic stroke were included. ICMs were implanted 13 days (interquartile range; 10–65 days) after the qualifying event. Seven-day Holter was performed after the ICM was implanted.

The iAF was detected by the ICM in 10 patients (17%; 95% CI, 7% to 26%). Only one patient (1.7%; 95% CI, 0% to 5%) had iAF during 7-day Holter monitoring as well (p=0.0077). Episodes of iAF lasting two minutes or more were detected 64 (range, 1–556) days after implantation. There were no recurrent strokes during the observation period.

The implantation procedure was well tolerated with no adverse events; the daily data transmission protocol was easy to handle by the patients.


1. Ritter MA, Kochhäuser S, Duning T, et al. Occult atrial fibrillation in cryptogenic stroke. Stroke 2013.​STROKEAHA.111.676189

Published on: March 27, 2013

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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