Utility Of Implantable Loop Recorders for Arrhythmia Detection Beyond
Atrial Fibrillation in Cryptogenic Stroke Patients
Abstract
Introduction Implantable loop recorders (ILR) are recommended
to detect atrial fibrillation (AF) in cases of cryptogenic stroke (CS).
However, the utility of loop recorder for detection of other actionable
arrhythmias in these patients is limited. Objective: To
evaluate the utility of ILR to detect arrythmias other than AF in
patients with cryptogenic stroke. Methods: We enrolled
consecutive CS patients referred for an ILR. A retrospective chart
review was conducted from 2018 to 2021. All patients were monitored for
a minimum of one year. Results: The cohort included 260
consecutive patients with cryptogenic stroke with a mean age of 68. 2
+/- 13.27 years patients of this cohort had at least one actionable
arrhythmic event. AF was found in 47 (18%) patients and 44 (17%)
patients were found to have other arrhythmias. Out of these 44 patients,
23 patients (9%) were found to have supraventricular tachycardias
(SVT), 4 patients (2%) had ventricular tachycardias, 9 patients (3%)
had pauses, 8 patients (3%) had significant bradycardia events.
Anticoagulation was initiated in all 47 patients with AF. A total of 15
patients (6%) underwent procedures which included 7 pacemakers, 1
implantable cardioverter-defibrillator, 1 SVT ablation, 6
electrophysiology studies because of ILR findings. Conclusion:
ILRs can successfully identify AF in patients with cryptogenic stroke.
However, there is a high incidence of other arrythmias that can be
detected by implanting ILRs that would otherwise would not be identified
or have delayed detection. The study demonstrates the advantage of
long-term remote monitoring of patients with CS beyond AF detection.