Bernstein and colleagues (JAMA 2021; 325:2169-2177. PMID: 34061145) evaluated whether long term monitoring with an implantable cardiac monitor (ICM) is more effective than usual care for AF detection in patients with stroke from large- or small-vessel disease. Overall, 242 patients were randomized to ICM insertion within 10 days of the index stroke. Patients in the control group (n = 250) received site-specific usual care with external cardiac monitoring, such as 12-lead electrocardiograms, Holter monitoring, telemetry, or event recorders. The primary outcome was AF lasting more than 30 seconds. The median (interquartile range) CHA2DS2-VASc score was 5 (4-6). AF detection at 12 months was significantly higher in the ICM group vs the control group (27 patients [12.1%] vs 4 patients [1.8%]; HR: 7.4, P < .001). The authors conclude that monitoring with an ICM compared with usual care detected significantly more AF over 12 months.

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Accepted: July 6, 2021

Received: July 3, 2021

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DOI: https://doi.org/10.1016/j.hrthm.2021.07.004

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