136-83: Results of monitoring large artery cryptogenic embolic stroke survivors using implantable loop recorder device

Abstract

Cryptogenic embolic large artery stroke secondary prevention is mayor dilemma in clinical praxis. Objective: To evaluate the incidence of cardiac arrhythmias in patients with cryptogenic stroke patients using implantable loop recorder device. Methods: Since April 2014, in Riga Sradins Clinical University Hospital 32 larger artery stroke survivors with mean age 55.3 years were included in the study. All patients had favorable functional outcome on discharge (modified Rankin score-rating-0-2). 23 (71.9%) patients received antithrombotic treatment, all patients underwent 24h ECG holter monitoring, transthoracic and transoesophageal echocardiogrphy, computed tomography angiography and genetic testing to exclude specific cause for stroke. Included patients gave consent to implant implantable loop recorder device and agreed to participate in the study. On discharge oral anticoagulants, preferably novel oral anticoagulants, were prescribed. Implantable loop recorder device findings were monitored 30 and 180 days after discharge in person and for patients that didn't show any finding on distance control after 365 days. Results: 12 patients were discharged on warfarin and 20 patients on novel oral anticoagulants. Paroxysmal or persistent atrial fibrillation was found in 10 (31.2%) patients. Episodic sinus tachycardia was found in 4 patient. Asystole episodes were found in 4 patient. Episodes of sinus bradycardia was found in 8 patients. And 12 patients are currently with no pathologic finding in first year. The monitoring is finished for 12 patients. 4 permanent pacemaker were implanted. Conclusion: Cardiac thromboembolism is a mayor cause for cryptogenic cerebral infarction. Sometimes routine diagnostics performed in most hospitals are insufficient for diagnosing cardiac causes in stroke survivors. Although results take a long time to come by the implantable loop recorder device can be used for diagnosing cardiac causes for cryptogenic stroke.