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首页> 外文期刊>The American Journal of Cardiology >Comparison of the Effect of Atrial Fibrillation Detection Algorithms in Patients With Cryptogenic Stroke Using Implantable Loop Recorders
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Comparison of the Effect of Atrial Fibrillation Detection Algorithms in Patients With Cryptogenic Stroke Using Implantable Loop Recorders

机译：使用植入环记录术术语患者心房颤动检测算法对阴性脑卒中患者的影响

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摘要

Occult atrial fibrillation (AF) can be the underlying cause for cryptogenic stroke (CS). Implantable loop recorders (ILRs) have become an important tool for long-term arrhythmia monitoring in CS patients. Office-based ILR implantation by nonelectrophysiologist physicians is increasingly common. To report the real world diagnostic yield and accuracy of remote ILR monitoring in high risk CS patients, we retrospectively analyzed 145 consecutive patients with CS who underwent ILR implantation between October 2014 and October 2018 at New York University Langone Health. A certified device technician and an electrophysiologist adjudicated all transmissions. The yield and accuracy of Reveal LINQ Intra Cardiac Monitor (ICM), a fourth generation device, was compared to that of TruRhythm Detection algorithm (fifth generation device). AF was diagnosed in 17 patients (12%) over a mean follow-up of 28 +/- 12 months. The median time to diagnosis was 7.4 +/- 21.3 months. A total of 1,637 remote transmissions (scheduled- and auto-triggered alerts: 756; patient-triggered: 881) were adjudicated. The positive predictive value for AF episodes in the scheduled interrogations increased from 4% in the Reveal LINQ ICM to 16% in the TruRhythm LINQ. Of 881 patient-triggered transmissions, none were found to be true positive. In the Reveal LINQ ICM, for scheduled transmissions, primary causes of false positive (FP) were atrial ventricular premature complexes (80%). In the TruRhythm LINQ, for scheduled transmissions, primary cause of FP were T-wave over-sensing (87%). In conclusion, the real world diagnostic yield of ILR for patients with CS remains suboptimal, with at least 84% of AF alerts being FP. Patient-riggered events did not correlate with arrhythmia and the necessity of patient triggering in this population should be questioned. Expert interpretation of recordings is critical to assure accurate diagnosis. (C) 2020 Elsevier Inc. All rights reserved.
机译：隐匿性心房颤动（AF）可能是隐源性中风（CS）的根本原因。植入式循环记录仪（ILR）已成为CS患者长期心律失常监测的重要工具。由非电生理医师进行的办公室ILR植入越来越普遍。为了报告高危CS患者远程ILR监测的真实诊断率和准确性，我们回顾性分析了2014年10月至2018年10月期间在纽约大学Langone Health接受ILR植入的145例连续CS患者。一名认证设备技术员和一名电生理学家对所有传输进行了裁决。第四代设备Reveal LINQ心脏内监护仪（ICM）与第五代设备Trurhytim Detection algorithm（Trurhytim Detection algorithm）的产量和准确性进行了比较。在平均28+/-12个月的随访中，17名患者（12%）被诊断为房颤。诊断的中位时间为7.4+/-21.3个月。共有1637次远程传输（计划和自动触发警报：756次；患者触发：881次）被裁定。在计划审讯中，房颤发作的阳性预测值从暴露LINQ ICM中的4%增加到了TRURTHERMATION LINQ中的16%。在881例患者触发的传播中，没有一例被发现为真阳性。在LINQ ICM中，对于计划传播，假阳性（FP）的主要原因是房性室性早搏（80%）。在TRUQ中，对于定时传输，FP的主要原因是T波过度感应（87%）。总之，CS患者ILR的真实诊断率仍然不理想，至少84%的房颤警报为FP。患者触发的事件与心律失常无关，在该人群中患者触发的必要性应该受到质疑。专家对记录的解释对于确保准确诊断至关重要。（C） 2020爱思唯尔公司版权所有。

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    Chorin Ehud; Peterson Connor; Kogan Edward; Barbhaiya Chirag; Aizer Anthony; Holmes Douglas; Bernstein Scott; Schole Michael; Duraiswami Harish; Spinelli Michael; Park David; Chinitz Larry; Jankelson Lior;

  • 作者单位

    NYU Langone Hlth Lenon H Charney Div Cardiol Cardiac Electrophysiol New York NY 10016 USA;

    NYU Langone Hlth Lenon H Charney Div Cardiol Cardiac Electrophysiol New York NY 10016 USA;

    NYU Langone Hlth Lenon H Charney Div Cardiol Cardiac Electrophysiol New York NY 10016 USA;

    NYU Langone Hlth Lenon H Charney Div Cardiol Cardiac Electrophysiol New York NY 10016 USA;

    NYU Langone Hlth Lenon H Charney Div Cardiol Cardiac Electrophysiol New York NY 10016 USA;

    NYU Langone Hlth Lenon H Charney Div Cardiol Cardiac Electrophysiol New York NY 10016 USA;

    NYU Langone Hlth Lenon H Charney Div Cardiol Cardiac Electrophysiol New York NY 10016 USA;

    NYU Langone Hlth Lenon H Charney Div Cardiol Cardiac Electrophysiol New York NY 10016 USA;

    NYU Langone Hlth Lenon H Charney Div Cardiol Cardiac Electrophysiol New York NY 10016 USA;

    NYU Langone Hlth Lenon H Charney Div Cardiol Cardiac Electrophysiol New York NY 10016 USA;

    NYU Langone Hlth Lenon H Charney Div Cardiol Cardiac Electrophysiol New York NY 10016 USA;

    NYU Langone Hlth Lenon H Charney Div Cardiol Cardiac Electrophysiol New York NY 10016 USA;

    NYU Langone Hlth Lenon H Charney Div Cardiol Cardiac Electrophysiol New York NY 10016 USA;

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  • 正文语种 eng
  • 中图分类 心脏、血管（循环系）疾病;
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