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| (ASSERT) Subclinical Atrial Fibrillation and the Risk of Stroke _____ A prospective observational study in which patients aged ≥65 with hypertension, a recently implanted pacemaker or defibrillator, and no history of A Fib were monitored for subclinical atrial tachyarrhythmias for 3 months and followed for a mean of 2.5 years to assess risk of ischemic stroke or systemic embolism before being randomly assigned to receive or not receive atrial overdrive pacing. Subclinical atrial tachyarrhythmias were detected in 10.1% of patients at a median of 36 days and were associated with an increased risk of clinical A Fib and ischemic stroke or embolism. Continuous overdrive pacing was not found to prevent A Fib. | LINK |
| (CRYSTAL AF) Cryptogenic Stroke and Underlying Atrial Fibrillation _____ A RCT assigning patients ≥40 years old with cryptogenic stroke and no evidence of A Fib on at least 24h of ECG monitoring to insertable cardiac monitor (ICM) or conventional follow up, with the primary endpoint of time to first detection of >30 seconds of A Fib within 6 months. At 6 months, A Fib was found in 8.9% of ICM patients and 1.4% of control patients. At 12 months, A fib was detected in 12.4% of ICM patients and 2.0% of control patients, both significant differences. The rate of oral anticoagulation use was significantly higher in the ICM group. | LINK |
| (STROKE-AF) Effect of Long-Term Continuous Cardiac Monitoring vs Usual Care on Detection of Atrial Fibrillation in Patients with Stroke Attributed to Large- or Small-Vessel Disease _____ A RCT enrolling patients aged ≥60 or 50-59 with additional stroke risk factors who had an index stroke attributed to large or small vessel disease, assigned to insertable cardiac monitor (ICM) placement or routine cardiac monitoring for detection of atrial fibrillation of at least 30 seconds. Detection of atrial fibrillation was significantly higher in the ICM group (12.1% vs 1.8%), though the clinical significance of this is uncertain. | LINK |
| (EMBRACE) Atrial Fibrillation in Patients with Cryptogenic Stroke _____ A RCT assigning patients ≥55 years old with cryptogenic stroke in the last 6 months and no known history of A fib on 24 hour ECG to undergo 30-day cardiac event monitoring or standard 24 hour monitoring, with the primary outcome of newly detected A Fib lasting ≥30 seconds within 90 days. A Fib lasting ≥30 seconds was identified significantly more frequently in the monitoring group than the control group (16.1% vs 3.2%), as well as A fib lasting ≥2.5 minutes (9.9% vs 2.5%). Significantly more patients in the intervention group were prescribed oral anticoagulation. | LINK |