In patients who have experienced certain types of common stroke, a small chip inserted under the skin can help doctors predict their likelihood of a second stroke and therefore their likelihood of benefiting from therapy. preventive. The results come from a recent clinical trial published in the Journal of the American Medical Association and led by researchers at Massachusetts General Hospital (MGH) and Northwestern University Feinberg School of Medicine.
Each year, approximately 800,000 strokes occur in the United States and up to a quarter occur in people who experienced a previous one. stroke. Researchers have been looking for ways to identify patients who are likely to experience recurrent stroke, as these individuals could be candidates for taking certain medications, such as anticoagulants. One of the patients who have a high risk of recurrent stroke are those with atrial fibrillation—An irregular and often rapid heart rate — which is often not detected or treated. (Irregular heartbeats can allow blood to bind to the heart, which can lead to clots and travel to the brain).
Recent research has shown that a small chip inserted under the skin can control heart rate and rhythm and help doctors detect atrial fibrillation in patients who previously experienced what is known as a cryptogenic stroke, one without a cause. identified despite exhaustive patient testing. Researchers have now tested the chip, less than 1¾ “long and 1/6” thick and called an insertable heart monitor, in patients who experienced a stroke caused by the narrowing of a large artery such as the carotid artery. or the blockage of a small deep artery in the brain where atrial fibrillation would be unexpected.
In the trial of known cause stroke and underlying atrial fibrillation (STROKE AF), 492 patients were randomized and completed 12 months of follow-up after receiving an insertable heart monitor within 10 days of a stroke. initial or routine care that consisted of external cardiac monitoring using electrocardiograms or other follow-up methods.
The chip detected atrial fibrillation in 12.1% of patients, compared with 1.8% detected by regular care. The team noted that the episodes of atrial fibrillation were not brief, and most lasted at least an hour. Most stroke experts would recommend that patients with this degree of atrial fibrillation begin taking anticoagulants to prevent future stroke.
“We found that a significant minority of stroke patients who are not thought to be related to atrial fibrillation actually have atrial fibrillation, but we can only find it with an implantable monitor,” says lead author Richard A. Bernstein, MD, Ph.D. , professor of neurology at Northwestern University Feinberg School of Medicine.
Adds lead author Lee H. Schwamm, MD, C. Miller Fisher, president of vascular neurology at MGH: “Based on the results of the study, we believe that stroke patients who are similar to those in the STROKE AF process they should now undergo long-term cardiac monitoring with an insertable heart monitor to identify unexpected atrial fibrillation. “
Schwamm notes that for every eight patients controlled, doctors might expect to find atrial fibrillation in one of them in the first year. “This could drastically change your doctor’s treatment recommendations,” he says.
The next steps in this research include identifying patient factors that predict the development of atrial fibrillation and the duration and extent of the arrhythmia. Additional studies are being explored to further understand the association of the silent headset fibrillation and recurring stroke of all kinds.
Bernstein RA et al. Effect of long-term continuous cardiac follow-up vs. regular attention on the detection of atrial fibrillation in stroke patients attributed to large or small vessel diseases: randomized clinical trial STROKE-AF. JAMA, (2021). DOI: 10.1001 / jama.2021.6470
Massachusetts General Hospital
Citation: The chip inserted under the skin can better identify patients at risk of recurrent stroke (2021, June 1) recovered on June 1, 2021 at https://medicalxpress.com/news/2021-06-chip- inserted-skin-patients-recurrent. html
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