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Heart-Rhythm Monitoring for Evaluation of Cryptogenic Stroke

Heart-Rhythm Monitoring for Evaluation of Cryptogenic Stroke | Heart and Vascular Health | Scoop.it

Observational studies suggest that we often fail to detect paroxysmal atrial fibrillation as the cause of ischemic stroke. However, owing to the limitations of existing studies, guidelines have yet to endorse specific strategies for detecting atrial fibrillation in patients with a new stroke. The results of two studies published in this issue of the Journal indicate that prolonged monitoring of heart rhythm should now become part of the standard care of patients with cryptogenic stroke.leaving it unclear whether monitoring improves diagnosis as compared with routine follow-up. 

Seth Bilazarian, MD's insight:

Our patients want to avoid stroke because of the debilitating effects it can have on functional status and quality of life.  Efforts to prevent a second stroke are enthusiastically embraced by patients.

Cryptogenic is stroke that a cause cannot be determined (about 1/3 of strokes).  Treatment with anticoagulants in this patient population is not recommended UNLESS the cause of the stroke is from the common irregular heart rhythm atrial fibrillation (AF).  

On the other hand if atrial fibrillation is NOT detected treatment with aspirin or other anti-platelet drugs are used and these drugs are inferior to anticoagulants if AF is the cause.

Two studies in NEJM showed that prolonged monitoring (30 days or 6 months)  increased the detection of AF and allowed more patients to be started on anticoagulants for stroke prevention.

In the trial of 30 days of recording with an external (carried) monitor was 16.1%.

In the trial of the implanted recorder detection of AF was 

at 6 months 8.9%

at 12 months 12%

at 36 months 36%

 The strategy of prolonged monitoring with an external device  for 1 month or 6 months with an implanted device is an unresolved question and adoption of the small subcutaneous device pictured above, will be limited by its cost, until further studies showing stroke reduction can be completed justifying its cost.

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Controlling Hypertension (High Blood Pressure) Via Kidney = Renal Denervation

Controlling Hypertension (High Blood Pressure)  Via Kidney = Renal Denervation | Heart and Vascular Health | Scoop.it

New experimental treatment for stubborn hypertension: Singeing the walls of nerve-lined arteries leading to the kidneys, blocking the organs' ability to raise blood pressure.

 

Medtronic is investigating a renal denervation strategy in a trial called Symplicity.  Procedure takes about 30 - 40 minutes. The study will target 530 patients with systolic blood pressure over 160 despite taking at least three medicines.  "Until now, there were no other options for such patients, other than adding more drugs".

 

For patients with resistant hypertension interested in clinical trial participation in Symplicity contact the clincial research office at (978) 469-5494 or visit the website http://www.pmaonline.com/clinical-trials.htm ;

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