Author + information
- Received April 23, 2018
- Revision received May 31, 2018
- Accepted June 4, 2018
- Published online November 19, 2018.
- Shaun Giancaterino, MD,
- Florentino Lupercio, MD,
- Marin Nishimura, MD and
- Jonathan C. Hsu, MD, MAS∗ ()
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
- ↵∗Address for correspondence:
Dr. Jonathan C. Hsu, Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California-San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, California 92037.
Insertable cardiac monitors (ICMs) are small, subcutaneously implanted devices offering continuous ambulatory electrocardiogram monitoring with a lifespan up to 3 years. ICMs have been studied and proven useful in selected cases of unexplained syncope and palpitations, as well as in atrial fibrillation (AF) management. The use of ICMs has greatly improved our ability to detect subclinical AF after cryptogenic stroke, and application of this technology is growing. Despite this, current stroke and cardiology society guidelines are lacking in recommendations for monitoring of subclinical AF following cryptogenic stroke, including the optimal timing from stroke event, duration, and method of electrocardiogram monitoring. This focused review outlines the current society guidelines, summarizes the latest evidence, and describes current and future use of ICMs with an emphasis on detection of subclinical AF in patients with cryptogenic stroke.
Dr. Hsu has received consulting and speaking honoraria from Medtronic, St. Jude Medical, Boston Scientific, and Biotronik; and has received research grants from Biosense Webster and Biotronik. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 23, 2018.
- Revision received May 31, 2018.
- Accepted June 4, 2018.
- 2018 American College of Cardiology Foundation
- Central Illustration
- Review of Insertable Cardiac Monitoring Technology
- Indications for Insertable Cardiac Monitors
- Guidelines for Insertable Cardiac Monitors in Syncope
- Evidence for Insertable Cardiac Monitors in Syncope
- Guidelines for Monitoring for Atrial Fibrillation After Stroke
- Evidence for Subclinical Atrial Fibrillation and Stroke Risk
- Detection of Subclinical Atrial Fibrillation in Cryptogenic Stroke
- Detection of Subclinical Atrial Fibrillation in Patients at High Risk for Atrial Fibrillation and Stroke
- Future Directions
- Future Studies