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Del Greco M, Natale A, Kusano K, Verma A, Beinart S, Diener HC, Amin A, Kasner S, Pouliot E, Noreli F, Mittal A. Atrial fibrillation in unexplained syncope: observations from the Reveal LINQ registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Implantable loop recorders (ILRs) have come to play an important role in the workup of patients with recurrent syncope of uncertain origin. In addition to detecting bradyarrhythmias related to syncope, which is the main diagnostic focus in these patients, ILRs are also capable of uncovering subclinical atrial fibrillation (AF).
Purpose
We sought to determine the percentage of patients monitored with an ILR for unexplained syncope who have AF detected and to describe clinical actions taken in these patients.
Methods
Patients enrolled in the Reveal LINQ Registry who received an ILR for unexplained syncope and had at least one follow-up form were included. The device automatically detects AF episodes lasting ≥2 minutes. Patients were considered to have AF based on an AF diagnosis made by the treating physician during follow-up or if device-detected AF was adjudicated as true AF by an external reviewer. AF detection rates were calculated using Kaplan-Meier methods.
Results
In total, 498 patients (aged 61.8±20.0 years, 49.6% female, CHA2DS2VASc score 2.2±1.7) were included and followed for 22±12 months. A history of AF was present in 97 (20%) patients, while 401 patients had no history. By 18 months, the incidence of AF was 70.9% (95% CI, 60.8%, 80.3%) in patients with a history of AF and 21.4% (95% CI, 17.4%, 26.1%) in patients without (Figure). AF detection in those with (30.4%) and without (30.1%) syncope during follow-up was similar. By the end of follow-up, and among patients with newly detected AF, 29/86 (33.7%) were on oral anticoagulation, 7 (8.1%) underwent AF ablation, 6 (7.0%) underwent other type of ablation, and 2 (2.3%) received cardioversion. Other actions among the whole cohort included implant of an IPG, ICD, or CRT in 98/498 (19.7%).
Conclusion
Among patients monitored with ILRs to determine the cause of recurrent syncope episodes, approximately 1 in 5 patients had new AF detected. In addition to improving the management of patients with syncope, ILR data served to support AF-related clinical decisions.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Medtronic Inc Incidence of AF according to baseline AF
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Affiliation(s)
- M Del Greco
- Santa Maria del Carmine Hospital, Cardiology, Rovereto, Italy
| | - A Natale
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, United States of America
| | - K Kusano
- National Cerebral and Cardiovascular Center Hospital, Cardiovascular Medicine, Osaka, Japan
| | - A Verma
- Southlake Regional Health Centre, Department of Cardiology, Newmarket, Canada
| | - S Beinart
- Washington Adventist Hospital, Center for Cardiac and Vascular Research, Rockville, United States of America
| | - H.-C Diener
- University Hospital of Essen (Ruhr), Neurology, Essen, Germany
| | - A Amin
- University of California at Irvine, Department of Medicine, Irvine, United States of America
| | - S Kasner
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, United States of America
| | - E Pouliot
- Medtronic, Inc., Minneapolis, United States of America
| | - F Noreli
- Medtronic, Inc., Minneapolis, United States of America
| | - A Mittal
- Valley Health System, Snyder Center for Comprehensive Atrial Fibrillation, Ridgewood, United States of America
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Simpson D, Goldenberg J, Kasner S, Nash M, Reding M, Zweifler R, Suarez G, Zhao P, III H, Rabinowicz A, Carrazana E. Dalfampridine in chronic sensorimotor deficits after ischemic stroke: A proof of concept study. J Rehabil Med 2015; 47:924-31. [DOI: 10.2340/16501977-2033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mullen M, Kasner S, Kallan M, Kleindorfer D, Albright K, Carr B. Joint Commission Primary Stroke Center Certification Increases rt-PA Treatment (PD2.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.pd2.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mullen M, Kasner S, Messe S. Seizures Do Not Increase In-Hospital Death after Intracranial Hemorrhage (PD2.008). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.pd2.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Chiu D, Grotta JC, Krieger D, Kasner S, Villar C, Bratina P, Vital D. Discussion of mitchell JB, Ballard DJ, whisnant JP, et al. What role do neurologists play in determining the costs and outcome of stroke patients? stroke 1996;27:1937–1943. J Stroke Cerebrovasc Dis 1998; 7:267-71. [PMID: 17895097 DOI: 10.1016/s1052-3057(98)80039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/1997] [Accepted: 02/18/1998] [Indexed: 10/24/2022] Open
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