When each device is compared incrementally , BioMonitor 2-AF dominates Reveal LINQ and Confirm RX .
BACKGROUND Cryptogenic stroke is a stroke for which no cause is identified after st and ard diagnostic tests .
Long-term implantable cardiac monitors may be better at diagnosing atrial fibrillation and provide an opportunity to reduce the risk of stroke recurrence with anticoagulants .
OBJECTIVES The objectives were to assess the diagnostic test accuracy , clinical effectiveness and cost-effectiveness of three implantable monitors [ BioMonitor 2-AF ™ ( Biotronik SE & Co. KG , Berlin , Germany ) , Confirm Rx ™ ( Abbott Laboratories , Lake Bluff , IL , USA ) and Reveal LINQ ™ ( Medtronic plc , Minneapolis , MN , USA ) ] in patients who have had a cryptogenic stroke and for whom no atrial fibrillation is detected after 24 hours of external electrocardiographic monitoring .
Total atrial conduction time to predict occult atrial fibrillation after cryptogenic stroke
Background Insertable cardiac monitor ( ICM ) increases the detection rate of occult atrial fibrillation ( AF ) after cryptogenic stroke . The aim of this study was to evaluate the prognostic significance of  total atrial conduction time ( TACT )  assessed by tissue Doppler imaging ( PA-TDI interval ) to predict AF presence in patients with cryptogenic stroke . Methods Ninety patients ( 57.7 ± 12.3 years , 48 % women ) after acute cryptogenic stroke and ICM implantation were prospect i ve recruited at four centers for continuous rhythm monitoring . In all patients , TACT was measured by PA-TDI interval via echocardiography . Patients were followed up ( 331 ± 186 days ) for detection of AF ( defined by episode lasting ≥30 s ) . Results AF was detected in 16 patients ( 18 % ) during follow-up ( 331 ± 186 days ) . The median period to AF detection was 30 days ( q1–q3 ; 16–62 days ) . Patients who exhibited occult AF were characterized by significantly longer PA-TDI intervals ( 154.7 ± 12.6 vs. 133.9 ± 9.5 ms , p < 0.0001 ) . The cut-off value of PA-TDI interval at 145 ms demonstrated sensitivity and specificity for AF detection of 93.8 and 90.5 % , respectively . In multivariate analysis , CHA2DS2–VASc score ( HR 1.96 per 1 point , p < 0.01 ) and longer PA-TDI interval ( HR 4.05 per 10 ms , p < 0.0001 ) were independent predictors of occult AF . Conclusion Our data suggest that measurement of TACT could help to predict future AF detection in patients with cryptogenic stroke . The clinical importance of prolonged rhythm monitoring or indication of direct anticoagulation therapy after cryptogenic stroke based on TACT should be further investigated
When each device is compared incrementally , BioMonitor 2-AF dominates Reveal LINQ and Confirm RX .
BACKGROUND Cryptogenic stroke is a stroke for which no cause is identified after st and ard diagnostic tests .
Long-term implantable cardiac monitors may be better at diagnosing atrial fibrillation and provide an opportunity to reduce the risk of stroke recurrence with anticoagulants .
OBJECTIVES The objectives were to assess the diagnostic test accuracy , clinical effectiveness and cost-effectiveness of three implantable monitors [ BioMonitor 2-AF ™ ( Biotronik SE & Co. KG , Berlin , Germany ) , Confirm Rx ™ ( Abbott Laboratories , Lake Bluff , IL , USA ) and Reveal LINQ ™ ( Medtronic plc , Minneapolis , MN , USA ) ] in patients who have had a cryptogenic stroke and for whom no atrial fibrillation is detected after 24 hours of external electrocardiographic monitoring .