Abstract
Introduction
Atrial fibrillation (AF) is suspected as the main cause of stroke in the majority
of patients presenting with cryptogenic stroke (CS). Implantable loop recorders (ILR's)
are indicated for detecting AF in these patients.
The short term (<1 month) and long-term AF detection rates in patients inserted with
an ILR immediately after CS is reported. Secondly, we compare the safety of nurse
led vs physician led ILR implantation in these patients.
Methods
This is a retrospective review of all patients who underwent inpatient ILR implantation
(Medtronic Linq) between May 2020 and May 2022 at East Sussex Healthcare NHS trust.
All patients were remotely monitored via the FOCUSONTM monitoring and triage service.
Results
A total of 186 subjects were included in the study and were followed up for a mean
period of 363.0 +/− 222.6 days. The mean time between stroke and ILR was 7.0 +/− 5.5
days. The mean time between referral and ILR was 1.0 +/− 2.0 days. AF was detected
in 25 (13.4%) patients. During the first 30 days of monitoring, AF was detected in
9 (4.8%) patients.
The number of ILR implants performed by the specialist nurse was 107 (57.5%). There
was no significant difference in the major complication rate (requiring device removal)
between nurse and physician led implant (1 (0.95%) vs 0 (0%), p value = 0.389).
Conclusion
Inpatient ILR for cryptogenic stroke is feasible. The rate of AF detection in the
first month post CS is 4.8% however, more AF was detected up to one year post implant,
suggesting rationale for proceeding directly to ILR implant in these patients before
discharge to not delay treatment. A nurse led service is also viable with no significant
difference in the major complication rate compared to physician led implants.
Keywords
Abbreviations:
ILR (implantable loop recorder), AF (atrial fibrillation), CS (cryptogenic stroke)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 14, 2023
Accepted:
January 9,
2023
Received in revised form:
January 7,
2023
Received:
December 1,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.106988
Copyright
© 2023 Elsevier Inc. All rights reserved.
