Neurology：植入性循环心电检测仪明显提高隐源性卒中的房颤检出率

隐源性卒中的原因探讨一直是卒中研究的热点之一，来自剑桥大学的Paul E. Cotter等学者们利用植入性循环心电检测仪研究了隐源性卒中心房颤动的情况，发表在2013年4月23日的Neurology杂志上。该研究利用增加了心房颤动监测能力的设备 (Reveal XT)--植入性循环心电检测仪(ILR)检测隐源性卒中患者的心房颤动发生率及该类伴房颤患者的其他相关因素。结果显示：植入性循环心电检测仪明显提高隐源性卒中的房颤检出率。

本研究共纳入51例不明原因（隐源性）缺血性卒中患者，入院时常规影像及至少24小时Holter检查，随后植入ILRs监测设备。

患者的年龄在17到73岁之间（平均52岁）。其中30例患者有循环分流检查结果，22例患者有卵圆孔未闭（73.3%; 95%可信区间为[CI] 56.5%–90.1%）。13例患者中检测出房颤(25.5%; 95% CI 13.1%–37.9%)。房颤明显与年龄增大(p = 0.018)、心房传导阻滞（p = 0.02）、左房容量(p = 0.025)及ILR植入前检测的房性期前收缩(p = 0.004)相关。ILR检测到心房颤动的平均时间为48天(范围为0–154天)。

对不明原因卒中患者，ILR检测到的心房颤动发生率为25.5%。这种心房颤动的预测方式能够更好的用于研究。对于隐源性卒中患者ILRs或许在以后会发挥更大的作用。

与房颤相关的拓展阅读：

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Incidence of atrial fibrillation detected by implantable loop recorders in unexplained stroke.
OBJECTIVES
The usefulness of the implantable loop recorder (ILR) with improved atrial fibrillation (AF) detection capability (Reveal XT) and the factors associated with AF in the setting of unexplained stroke were investigated.
METHODS
A cohort study is reported of 51 patients in whom ILRs were implanted for the investigation of ischemic stroke for which no cause had been found (cryptogenic) following appropriate vascular and cardiac imaging and at least 24 hours of cardiac rhythm monitoring.
RESULTS
The patients were aged from 17 to 73 (median 52) years. Of the 30 patients with a shunt investigation, 22 had a patent foramen ovale (73.3%; 95% confidence interval [CI] 56.5%-90.1%). AF was identified in 13 (25.5%; 95% CI 13.1%-37.9%) cases. AF was associated with increasing age (p = 0.018), interatrial conduction block (p = 0.02), left atrial volume (p = 0.025), and the occurrence of atrial premature contractions on preceding external monitoring (p = 0.004). The median (range) of monitoring prior to AF detection was 48 (0-154) days.
CONCLUSION
In patients with unexplained stroke, AF was detected by ILR in 25.5%. Predictors of AF were identified, which may help to target investigations. ILRs may have a central role in the future in the investigation of patients with unexplained stroke.