Abstract TP219: Implantation With Reveal XT After Cryptogenic Stroke Is A Useful Tool To Detect Previously Undiagnosed Atrial Fibrillation

Abstract

Cryptogenic strokes are those ischemic cerebral events with no clear etiology, many of which have embolic characteristics. It is hypothesized that many of these emboli are due to undiagnosed and asymptomatic atrial fibrillation (AF). 1 Our study selected patients with cryptogenic strokes for implantation with the Reveal XT insertable cardiac monitor with the hope of detecting AF in these patients. Methods: Patients with ischemic strokes had MRI or CT performed to visualize the infarct. A neurologist determined as to whether the infarct was lacunar, and due to small vessel disease, or if it was an embolic appearing stroke based on the infarct’s size and location (cortical, wedge shaped infarct, multiple vascular territories, watershed territory). If the infarct appeared embolic, and the patient had no history of AF, a full stroke workup was initiated consisting of fasting lipid panel, bilateral carotid dopplers, MRA or CTA of the head, Transesophageal Echocardiogram (TEE), continuous telemetry and hypercoagualable labs if age of the patient was <50). If the stroke was in the posterior circulation, a CTA or MRA of the neck replaced the bilateral carotid dopplers. Patients who had an embolic appearing stroke with a negative TEE, no episodes of AF on cardiac telemetry, MRA or CTA negative for a focal area of stenosis, and carotid Doppler examinations showing less than 50% ipsilateral stenosis were diagnosed as having a cryptogenic stroke. These patients were then offered implantation with the Reveal XT with follow up by a cardiac electrophysiologist who would adjudicate any triggered episodes of atrial fibrillation. Results: Following this protocol, 22 patients were successfully implanted with the Reveal XT device. Of these patients, 9 were discovered to have AF, or 41% yield. Once diagnosed with atrial fibrillation, these patients were then placed on appropriate anticoagulation therapy. Conclusion: Based on the above results, the Reveal XT insertable cardiac monitor is useful in detecting AF in patients with embolic appearing cryptogenic strokes with otherwise negative workup, and can ultimately change the patient’s therapeutic regimen. Footnotes 1 Finsterer J, (June, 2010) “Management of Cryptogenic Stroke” Acta Neurol Belg . 110(2):135–47.