• Medicina clinica · Jul 2023

    Use of the insertable Holter with remote detection in the etiological diagnosis of cryptogenic stroke: Analysis of 73 patients.

    • Paula Lobato Casado, Álvaro Jamilena López, Jose Clemente Segundo Rodríguez, Marta Inmaculada Pachón Iglesias, María Del Mar Morín Martín, and Miguel Ángel Arias Palomares.
    • Unidad de Ictus, Servicio de Neurología, Complejo Hospitalario Universitario de Toledo, Toledo, España. Electronic address: paulalobatocasado@gmail.com.
    • Med Clin (Barc). 2023 Jul 21; 161 (2): 545854-58.

    IntroductionCryptogenic stroke constitutes 25% of all ischemic strokes, of which 20-30% are due to atrial fibrillation (AF). With the aim of increasing the detection rate, implantable long-term monitoring devices have emerged. The study of the profile of the ideal candidate subsidiary to such monitoring would provide a better understanding of the mechanisms underlying this subtype of stroke.ObjectiveTo determine which variables are related and can predict the detection of silent AF in patients with cryptogenic stroke.Patients And MethodsThis is a longitudinal cohort with recruitment from March 2017 to May 2022. They are patients with an implantable monitoring device and cryptogenic stroke with a minimum monitoring of one year.ResultsThe total number of patients included was 73, with a mean age of 58.8 years, 56.2% were male. AF was detected in 21 patients (28.8%). The most frequent cardiovascular risk factors were hypertension (47.9%) and dyslipidemia (45.2%). The most frequent topography was cortical (52%). Regarding the echocardiographic parameters, 22% had a dilated left atrium, 19% had a patent foramen ovale, and 22% had high-density supraventricular tachycardia (>1%) on Holter monitoring. In the multivariate analysis, the only variable that predicts AF is the presence of high-density supraventricular tachycardia, with an area under the curve of 0.726 (CI 0.57-0.87, p=0.04), sensitivity of 47.6%, specificity of 97.5%, positive predictive value of 90.9%, negative predictive value of 78.8%, and accuracy of 80.9%.ConclusionsThe presence of high-density supraventricular tachycardia can be indicative for predicting silent AF. No other variables have been observed that allow us to predict detection of AF in these patients.Copyright © 2023 Elsevier España, S.L.U. All rights reserved.

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