R2. 최태웅 / Pf. 김진배
BACKGROUND Ischemic stroke : leading causes of death and disability : cause remains unexplained after routine evaluation → Cryptogenic stroke Atrial fibrillation : well-recognized cause of ischemic stroke → stroke risk reduced by anticoagulation : paroxysmal & asymptomatic nature (may not be detected with traditional monitoring techniques)
BACKGROUND Strategies for detection of atrial fibrillation serial ECG, Holter monitoring monitoring with use of external event or loop recorders, long-term outpatient monitoring monitoring by means of insertable cardiac monitors (ICMs) Current guidelines recommend → at least 24 hr of ECG monitoring after an ischemic stroke to rule out atrial fibrillation → most effective duration and type of monitoring not established
Material and Method The Cryptogenic Stroke and Underlying AF(CRYSTAL AF) trial → parallel-group trial(randomized, controlled study) → comparing ICM vs conventional (24hr Holter, ECG, event recorder) f/u in patients with cryptogenic stroke or transient ischemic attack (TIA) The primary end point time to first detection of A-fib at 6 months of f/u Secondary end points time to first detection of A-fib at 12 months of f/u, recurrent stroke or TIA, and change in use of oral anticoagulant drugs
Material and Method
RESULTS
Detection of A-fib (6 months) 8.9% vs 1.4% (HR 6.4) Detection of A-fib (12 months) 12.4% vs 2.0% (HR 7.3)
RESULTS Detection of A-fib (36 months) 30% vs 3.0% (HR 8.8)
RESULTS
CONCLUSION ECG monitoring with an ICM was superior to conventional follow- up for detecting atrial fibrillation after cryptogenic stroke A-fib after cryptogenic stroke was most often asymptomatic and paroxysmal → unlikely to be detected by strategies based on symptom-driven monitoring or intermittent short-term recordings