Subtle Ultrasound Atrial Anomalies Predict Early Silent Atrial Fibrillation with Implantable Cardiac Monitor in Cryptogenic Stroke Patients A Randomized Trial

What this Trial Is About

Cryptogenic stroke (CS) causes about 30% of stroke unit admissions and often has an unknown cause. Silent paroxysmal atrial fibrillation (PAF) is believed to underlie many CS cases. This study evaluates the usefulness of implantable cardiac monitors (ICM) for early detection of silent PAF in patients with CS. The study also explores clinical and ultrasound predictors, such as atrial contraction strain (ACS), to identify patients at higher risk who may need closer monitoring. Patients admitted with CS are randomized within 48 hours of admission to either standard care or early ICM implantation before discharge. The ICM devices are implanted subcutaneously in the chest and programmed to detect atrial fibrillation episodes lasting 30 seconds or more. The study also uses cardiac ultrasound to assess atrial features like left atrial volume and strain to classify patients as having atrial cardiomyopathy or not. Standard care includes continuous ECG monitoring for at least 48 hours and follow-up ECGs and Holter monitoring. Participants undergo neurological exams, ECGs, brain imaging, and blood tests during admission and are followed up in outpatient clinics at 3, 6, 12 months, and every 6 months thereafter up to 2 years. Researchers will monitor for atrial fibrillation detection confirmed by ECG or device recordings, assess ultrasound predictors of PAF, and track stroke recurrence. All ICM recordings are reviewed by specialists, and oral anticoagulation is started if atrial fibrillation is detected.

Atrial Anomalies Predict Silent Atrial Fibrillation Detected by Implantable Cardiac Monitor in Cryptogenic Stroke