Het nut van implanteerbare looprecorders na een embolische beroerte van ongekende oorsprong

Abstract

The use of implantable loop recorders after embolic stroke of undetermined source Unknown intermittent atrial fibrillation (AF) is a potential source of embolism in patients with embolic stroke of undetermined source (ESUS). Prolonged heart rhythm monitoring with implantable loop recorders (ILR) could increase the detection of AF. Patients with detected (subclinical) AF may benefit from a therapy with anticoagulants after ESUS. The authors of this article performed a retrospective analysis of patients who received an ILR after suspected ESUS at the University Hospitals of Leuven (Belgium) between April 2008 and March 2019. They describe the proportion of patients in whom AF was detected and studied the predictors of AF detection. With prolonged monitoring, the AF detection rate increased, mainly in the first 2 years after implantation. AF was detected in 28 out of 84 patients (33.3%) after a median follow-up of 8 months. Patients with AF were significantly older and tended to have more arterial hypertension. All patients with detected AF received oral anticoagulation. Although a 24-hour Holter monitoring and a week recorder were negative for AF detection, an ILR established (subclinical) AF in 1 out of 3 patients after ESUS.