International Stroke Conference (ISC)
February 12-14, 2014

Just announced at ISC 2014 were the industry-sponsored Crystal-AF results by Rich Bernstein et al which REVEALed implantable cardiac monitoring at 6 months detected atrial fibrillation at least 6 times more often than conservative workup with shorter term monitoring.

Should I be increasing my use of these devices? Only a small percentage of patients had complications with pocket site infections; it seems harmless enough. I have actually never ordered implantable cardiac monitoring. I go for a simple 21 day Holter (or at our institution
14 day Ziopatch). Perhaps, implantable monitoring is a good option if you have a high suspicion for cardioembolic stroke and your non-invasive monitoring does not work after the first several weeks.

Several questions remain. The incidence of afib was relatively low. The definition of afib was greater than 30 seconds of irregular rhythm without p waves. Why 30 seconds? How many of you in practice initiate anticoagulation only if a certain duration of afib detected? I learned
that a few good seconds of afib was all I needed!

How long should the monitoring go on? This particular device is good for up to 3 years. The secondary outcomes showed increased detection with increased duration if monitoring, suggesting one can leave it in up to 3 years until you find afib.

I eagerly await the formal publication of results, and the community’s response: will you change your practice? 

Take this anonymous poll and see what others think. 


– Nirali Vora, MD