AUTHOR=Pikija Slaven , Rösler Cornelia , Leitner Ursula , Zellner Thomas , Bubel Nele , Ganser Bernhard , Hecker Constantin , Mutzenbach Johannes Sebastian 

TITLE=Neurologist-Led Management of Implantable Loop-Recorders After Embolic Stroke of Undetermined Source

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.816511

DOI=10.3389/fneur.2021.816511

ISSN=1664-2295

ABSTRACT=Introduction
Upon completed stroke workup, etiology can not be identified in approximately one-third of patients, with an embolic stroke of undetermined source (ESUS) accounting for around 50% of these cryptogenic etiologies. Whether management of complex long-term monitoring in order to detect suspected atrial fibrillation (AFib) could be initiated and managed through a neurologist is not sufficiently investigated. 
Patients and methods
We recruited all consecutive patients with ESUS that received implantation after neurological adjudication of Reveal LINQ® loop recorder between January 2016 and July 2020. We collected demographic, clinical, heart- and neuroimaging, laboratory, and electrocardiographic data assessed on prolonged baseline ECG monitoring - number of supraventricular (SVEs) and ventricular (VEs) extrasystolic complexes), and from pre-implantation ECG - PQ interval. AFib detection was manually supervised and determined positive when duration was over 120 seconds.
Results
We followed a total of 131 patients for a median of 504 days. There were 45 (34%) manually verified AFib diagnoses. In univariate analysis, earlier implantation after ESUS was associated with AFib detection (13 vs. 31 days, p=0.011). In multivariate analysis, increased rate of AFib was associated with the more prolonged PQ Interval (per 50-millisecond increase) (HR 1.99, 95% CI 1.39-2.85) and number of SVEs (HR 1.29, 95% CI 1.05-1.57) measured on pre-implantation ECG. 
Conclusion
We observed similar predictors for Afib after ESUS, albeit with higher frequency than previously reported. The neurologist-led decision, management, and evaluation of ILR after ESUS is feasible.