Diagnostic Yield of Extended Cardiac Patch Monitoring in Patients with Stroke or TIA
Tung, C., Turakhia, M., Lansburg, M., et al. (2014)
Frontiers in Neurology
It is important to evaluate patients with stroke or TIA for Atrial Fibrillation (AF), because the detection of AF changes the recommended anti-thrombotic regimen from treatment with an antiplatelet agent to treatment with oral anticoagulation (1). Atrial fibrillation (AF) is a well-recognized cause of stroke and transient ischemic attack (TIA) and recent studies of extended cardiac rhythm monitoring demonstrate that AF may be responsible for a greater proportion of unexplained strokes than previously realized.
In a systematic review and meta-analysis of 32 studies of patients with stroke or TIA the overall detection rate of AF was 11.5% (2). In the recent CRYSTAL-AF study, AF was detected in 29% of cryptogenic stroke patients who underwent 1 year of cardiac monitoring with an implantable cardiac loop recorder (3). The detection of supraventricular tachycardia (SVT) may be important as well as it is associated with the development of AF and an increased risk of stroke even in patients without AF (4,5,6). These results suggest an important role for extended cardiac monitoring in the evaluation of patients with stroke or TIA.
Because of memory and technical limitations, ambulatory cardiac monitoring has historically provided either short-term (up to 48 hours) continuous monitoring (Holter) or longer term intermittent monitoring (event or loop recorders). Longer term continuous monitoring has been limited by patient compliance, the analyzable wear time, and electrode skin irritation (7). A novel, patch-based, water-resistant cardiac patch rhythm monitor (Zio Patch) can provide continuous cardiac monitoring for up to 14 days. A recent study in patients with cardiac indications concluded that the patch monitor has high patient compliance, high analyzable time, and incremental diagnostic yield beyond 48 hours for all arrhythmia types (8). We investigated the diagnostic yield of the cardiac patch monitor for long-term continuous cardiac monitoring in a large nationwide sample of stroke and TIA patients.