![]() ![]() ![]() NHNN consultant neurologist Dr Arvind Chandratheva said: “There are a significant number of strokes where the cause is not clear. ICMs can continuously monitor cardiac rhythm for three to five years after implantation. The patient’s heart rhythms are sent via a mobile app or a small electronic monitor using Bluetooth technology, and the results are monitored remotely by stroke nurses and cardiac physiologists. The patient is given a small electronic transmitter to keep at home. ![]() Implanting a cardiac monitor is a simple, quick procedure, carried out in an outpatient setting. The NHNN is running a pilot of 20 cases in a bid to gather evidence to make a formal business case to commissioners. The guidance says it should be used after non-invasive ECG monitoring has been carried out and no other cause for the stroke has been found. The use of the Reveal LINQ II™ device made by Medtronic was approved by NICE in September 2020 as an option to help to detect AF after cryptogenic stroke and TIAs. As soon as we know, we can then get them on the appropriate treatment to prevent further strokes.” As a nurse, it is gratifying to be able to carry out the procedure in a timely way so our patients can feel reassured that that their heart rhythm is being constantly monitored to pick up any potential signs of what the problem may be. ![]() Selina said: “It can be very unsettling for our patients not knowing what caused their stroke and then living with the anxiety that it could happen again. Keeping the implantation within the stroke service speeds up the process of getting patients set up with monitoring and then getting them started on stroke-preventing anticoagulant treatment, if appropriate. The nurses manage the monthly Loop Recording Clinic at the NHNN and have successfully implanted eight patients to date with positive feedback. The devices are tiny, one-third of the size of an AAA battery. UCLH stroke nurse practitioners, Selina Edwards and Roberto Macarimban-Inglesant are the first stroke nurses trained to implant these miniature devices under the skin within a stroke-led service. Strokes attributed to AF are often more severe, with higher mortality and greater disability. Early identification and rapid initiation of anticoagulation has been shown to reduce risk of further strokes by two-thirds and could prevent around 7,000 strokes a year. The sooner the cause is identified, the sooner the patient can be put on the right treatment. Long-term monitoring reveals AF in around one in six cryptogenic stroke patients.ĪF can only be treated if it is detected. AF can be intermittent, short lived and asymptomatic making it challenging to identify. Missed AF is often suspected as the cause of cryptogenic stroke but long-term monitoring of a patient’s heart rhythm, which can take up to three years, is required to confirm this. One in four strokes and half of all TIAs do not present a cause after standard work up. The cardiac monitors detect atrial fibrillation (AF) in cryptogenic strokes or transient ischaemic attacks (TIA). Stroke patients at the National Hospital for Neurology and Neurosurgery (NHNN) are being implanted with heart monitors when the cause or origin of their stroke is unclear (known as cryptogenic stroke), making the stroke team the first in the NHS to carry out the implants on patients rather than refer them to a cardiology service. ![]()
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