Abstract TMP48: Long-Term Cardiac Monitoring in Cryptogenic Stroke: The San Diego Experience

Abstract

Purpose: Approximately 30% of all ischemic stroke (AIS) etiology is identified as cryptogenic. Implantable cardiac monitors (ICM) have become increasingly utilized based on results of the CRYSTAL-AF trial. Furthermore, this is now supported by current AHA guidelines. The purpose of this study was to assess the real-world reliability and experience of ICM in two large, academic Comprehensive Stroke Centers (CSC). Methods: We performed a retrospective review of prospectively collected data in two large, academic CSCs (UCSD Hillcrest Medical Center and UCSD Jacobs Medical Center/Sulpizio Cardiovascular Center). Patients were included if they had an AIS with cryptogenic etiology and had ICM placement between June 2017 and September 2023. Baseline demographics and ICM metrics were compared between patients that did or did not have atrial fibrillation (AF) detected with frequencies, chi-squared or t-test as appropriate. Results: A total of 134 patients were included (mean [SD]): age 69.1 years [12.5], female 40%, and median NIHSS 3 [SD 5]. AF was detected in 23.3%. Mean time to detection was 9.5 months (SD 12.8). The rate of detection was 13.5%, 18% and 21% at 6, 12, and 36 months since ICM implantation, respectively. Patients with AF were older at implantation (p=0.01) and had longer duration of monitoring (p<0.001). There was a significant difference in the number of ICM between sites (p=0.01). Males (p=0.01) and patients of white race were significantly more likely to have ICM. Despite this disparity, there was no significant difference in AF detection between sites (p=0.91), race/ethnicity (p= 0.12), or identified gender (p=0.43). Conclusions: Long-term cardiac monitoring has been shown to detect significant rates of AF, especially in cryptogenic stroke. Despite the small sample, this study found that over 20% of patients with cryptogenic stroke had AF. Examination of this population revealed disparities in implementation and placement pathways. More studies and process improvements are needed to identify and reduce disparities in this treatment-changing intervention.