Stroke impacts more than 795,000 people every year. More than 87% of strokes are ischemic strokes, which occur when vessels that allow blood to flow to the brain are blocked.1 AF is a major risk factor for ischemic stroke, increasing risk of stroke 5-fold compared with those patients who do not have AF.2
This retrospective case-crossover study leveraged data from 466,635 patients included in both the Optum deidentified electronic health record (EHR) and the Medtronic CareLink network databases. Of those, a total of 891 patients with Medtronic cardiovascular implantable electronic devices (CIEDs) capable of continuous rhythm monitoring sustained both an ischemic stroke and received 120 days of continuous monitoring prior to their stroke. A threshold of AF exposure was defined as AF lasting 5.5 hours or more on any given day. Patients were evaluated during a case period that included days 1 to 30 prior to the index stroke and a control period that included days 91 to 120 prior to the event. It was found that 76.5% (682/891) subjects had no AF meeting the threshold in either 30-day period, 16% (143/891) had at least one day with 5.5 hours or more of AF in both periods, and 7.4% (66/891) had informative, discordant rhythm patterns (defined as those that had AF exceeding 5.5 hours in only one period). Key findings were as follows:
Among patients with CIEDs with informative, discordant rhythm patterns, having AF of 5.5 hours or more raised the 30-day risk of ischemic stroke more than three-fold.
Stroke risk was highest within five days of a 5.5 hour or more episode of AF and diminished rapidly thereafter.
A temporal association between AF and stroke was not seen in patients who had been prescribed oral anticoagulants (OACs).
'Overall, these findings significantly underscore traditional thinking that AF is likely a causal risk factor for ischemic stroke as opposed to just a risk marker,' said
In this study, subjects evaluated had Medtronic CIEDs capable of continuous heart rhythm monitoring via the Medtronic CareLink network, including 114 patients with Medtronic insertable cardiac monitors (ICMs) and 777 with various Medtronic transvenous devices with atrial leads, including implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy (CRT) devices, and pacemakers.
'As of late, there has been significant discussion surrounding the temporal relationship of AF episodes to stroke, as well as the use of continuous cardiac monitoring, specifically with ICMs, to detect clinically meaningful AF episodes that may lead to a stroke,' said
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