P60 THE ELECTROPHYSIOLOGICAL DIAGNOSIS OF THE CRYPTOGENETIC STROKE

Abstract Introduction In the neurological field, one of the pathologies not yet fully clarified from an etiopathogenetic point of view is cryptogenic stroke. This definition applies to all those forms of stroke in which clinical–instrumental investigations have not been able to define the "primum movens". In the literature, a significant percentage of cryptogenic stroke is the result of Paroxysmal Atrial Fibrillation (FAP). Currently the recognition of asymptomatic and rapidly evolving forms of AF can be investigated with the use of implantable electrocardiographic recorders (Loop Recorder or ILR) which increase the recognition rate of AF compared to standard investigations. The Loop Recorders, monitoring the electrical activity of the heart, are automatically activated and record the event. This data, thanks to a transmission system, as well as being stored in the memory of the recorder and therefore being interrogated, is sent to a central server which in turn transmits it to the control room which stores the patient and the events remotely. Objectives To diagnose the cause of the cryptogenic Stroke through the implantation of the ILR with long–term monitoring, up to 36 months. Methods All patients admitted to the Stroke Unit with cryptogenic stroke were evaluated with the ESUS SCORE. Patients who tested positive at the administration of the score underwent Loop Recorder (ILR) implantation for prolonged cardiac monitoring in the clinical suspicion of FAP as the cause of cryptogenic stroke. The results of such monitoring were documented along with the duration of hospital cardiac monitoring. Results A total of 210 patients diagnosed with ischemic stroke or transient ischemic attack (TIA) were identified. Of the strokes, 22 (10.4%) were classified as cryptogenic. These patients underwent a Loop Recorder implant and were monitored for 12 months. 6 out of 22 patients (27.2%) were affected by atrial fibrillation and were treated with warfarin. Conclusion Continuous Loop Recorder monitoring changed the drug treatment of 27.2% of cryptogenic stroke patients due to intermittent AF detection despite no AF detection by electrocardiography and in–hospital telemetry monitoring.