In the Czech Republic, approximately 19,000 patients suffer a stroke each year. Most of them have various cardiac arrhythmias, the most common of which is atrial fibrillation. Helping to shed light on the hidden causes of stroke is now the aim of the independent academic study “Cardioneurology 2023”. The study will focus on long-term follow-up of stroke patients with an unclear cause and risk of cardiac embolism. The collaboration between cardiologists and neurologists will provide valuable data for uncovering hidden causes of stroke and help set recommended future practices.

“The results of the study will enable a change in the diagnostic procedure, which will lead to a greater detection of atrial fibrillation in these patients, which will improve secondary prevention and reduce the risk of recurrence of stroke, which is fatal for many patients,” comments Prof. Miloš Táborský, Vice-Chairman of the CCC and Head of the First Internal Medicine Clinic of the Faculty of Medicine of the University of Liberec and the University Hospital in Olomouc, who initiated and led the study.

Atrial fibrillation has been considered one of the most common causes of stroke in recent years, but in the case of the episodic form of this arrhythmia, its detection is difficult and often requires long-term monitoring of the heart rhythm using an ECG holter or an implantable cardiac monitor.

“Our goal should be to get as many patients as possible whose origin of stroke is unknown to be monitored – and then, of course, it is up to the cardiologists to decide what type of device, for how long and how to evaluate the data,” says doc. MUDr. Aleš Tomek, Head of the Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague.

However, no study has yet been conducted to target this specific group of patients at high risk of paroxysmal atrial fibrillation and determine its incidence.

“For a number of years, the standard of care has been to monitor heart rhythm for at least 4 weeks from the onset of the disease. The detection of atrial fibrillation during this monitoring ranges from 6-11% of patients. However, studies with long-term follow-up show that the incidence of this arrhythmia is both in the early period and later 3-6-9 months afterwards,” says Prof. Miloš Táborský.

How will patients be monitored?

The best chance of detecting atrial fibrillation or other arrhythmias is provided by implantable cardiac monitors, which ensure the longest possible monitoring period for the patient.

Subcutaneous monitors are statistically significantly more effective than conventional ECG monitoring in detecting arrhythmias. “The longer we monitor a patient, the more arrhythmias we catch. From this point of view, implantable cardiac monitors are definitely advantageous,” says Prof. MUDr. Miloš Táborský.

Doctors have good experience with the BioMonitor IIIm subcutaneous device, which provides continuous monitoring, automatic processing and evaluation of measured data. This is the technology that currently offers the longest possible monitoring period – more than three years are guaranteed, which also means the highest chance of detecting a heart rhythm disorder as a cause of stroke.

The technique of implanting cardiac monitors has advanced incredibly in the last 10-15 years, and the whole technology has been improved and simplified, making it very patient-friendly. The insertion of the BioMonitor IIIm is done in a kind of introducer injection that is simply inserted into the subcutaneous tissue parallel to the sternum. The whole procedure is quick and takes approximately 5 minutes.

Patient application and remote monitoring

Once the device is implanted, the patient is fitted with a patient remote monitoring unit where they are automatically monitored via the Home Monitoring system. Doctors are alerted to any potential episode of arrhythmia and can respond quickly. Currently, a smartphone app is also already available, which allows the patient to monitor their cardiac episodes, record their problems, communicate with the implantation centre, etc.

JK