Cryptogenic stroke: FibriCheck versus Insertable Loop Recorder – FibriCheck Academy

Introduction

This is the first report of a cryptogenic stroke patient in whom PPG-based mHealth (FibriCheck) was able to detect the occurrence and burden of paroxysmal atrial fibrillation (AF) episodes with similar precision as an insertable cardiac monitor (ICM). ICMs are the most performant rhythm monitoring devices according to studies device but they are expensive, invasive, and currently underutilized. This case demonstrates the feasibility and accuracy of implementing FibriCheck monitoring as a low-cost and non-invasive tool.

These results were published in Front. Cardiovasc. Med. by Femke Wouter et al (2022).
The full case report can be accessed here.

Case description

Age	59 years
Gender	Male
Comorbidities	Arterial hypertension
Medication	Chlortalidone 50 mg (diuretic) Quinapril 20 mg (ACE inhibitor) Atenolol 25 mg (beta-blocker)
Lifestyle	Sedentary lifestyle and former smoker
Admission	The patient woke up with aphasia and a headache. He presented himself to the emergency department the next day with normal vital parameters and word-finding difficulties

Diagnostics assessment

Examination

Findings

Lab results

Blood tests
No electrolyte or metabolic disturbances
HbA1c: 5.7%
LDL cholesterol level: 79 mg/dl
Total cholesterol: 145 mg/dl

Heart rhythm monitoring

ECG
Normal rhythm, mild sinus bradycardia (52 bpm)

67h ECG monitoring stroke unit
No AF detected

7-day Holter
No AF episodes or pauses
92 bradycardia events
2335 ventricular ectopic beats
481 supraventricular ectopic beats

Imaging

CT scan
Recent ischemia in the left temporoparietal cortex

CT angiography
No cause of the stroke identified

MRI
Confirmed recent ischemia with diffusion restriction in the corticocortical posterior temporal area

EEG
No signs of epilepsy

TEE
Could not confirm a cardiac source of emboli

The stroke was finally defined as cryptogenic due to a negative seven-day ECG Holter. According to the European Society of Cardiology (ESC) guidelines, prolonged cardiac monitoring is recommended to detect asymptomatic AF. Therefore, an ICM was inserted seven weeks after the stroke to monitor the heart rhythm continuously until battery end-of-service (i.e., average duration of three years). The patient was included in the clinical double-blind REMOTE study in which ICMs are compared to FibriCheck (ClinicalTrials.gov, Identifier: NCT05006105).

Within the scope of this study, the cryptogenic stroke patient was instructed to perform two one-minute spot-checks using the FibriCheck application each day, and additional spot-checks could be performed in case of symptoms during a period of 6 months.

Comparison between ICM and FibriCheck results

Before the ablation procedure, five AF episodes were detected on both the ICM and FibriCheck. The AF episodes were concurrently detected by an ICM and FibriCheck with an artificial intelligence algorithm to detect AF. The application detected all AF episodes identified by the ICM. Moreover, there were no false-positive FibriCheck recordings. Only three AF recordings (19%) were symptomatic (i.e., palpations and dizziness); two of these were recorded within the same hour.

Timeline of continuous and spot-check measurements performed by ICM and FibriCheck. A seven-day ECG Holter was used in the first month. At the end of the second month, the ICM was inserted, and the use of FibriCheck was initiated. Green bars indicate a sinus rhythm, red bars indicate an AF episode, dark red bars indicate a symptomatic AF episode as reported in the FibriCheck app, blue bars indicate insufficient data quality, and the black bar indicates the ablation.

Introduction

Case description

Diagnostics assessment

Comparison between ICM and FibriCheck results

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