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Opinion EDITORIAL Is There Enough Evidence to Treat? David Tirschwell, MD, MSc; Nazem Akoum, MD, MS Atrial fibrillation (AF), persistent or paroxysmal with high fre- gies has not been previously evaluated. The Post-Embolic quency, is present and assumed to be the cause or a contribut- Rhythm Detection with Implantable vs External Monitoring 1 7 (PER DIEM) trial ing factor in more than 20% of ischemic strokes in the US. The compared use of a 30-day external monitor prevalence of AF is accompanied by expanding evidence of vs a prolonged ICM in 300 patients within 6 months of non– infrequent and often shorter AF-related ischemic stroke (66% were cryptogenic). The pri- duration AF episodes in addi- mary outcome was subclinical AF (originally planned using a Related articles pages 2160 tional patients. Subclinical AF 30-second threshold but due to technical limitations of the ICM, and 2169 consists of asymptomatic, the protocol was modified to define subclinical AF as lasting low-frequency episodes of AF detected on heart rhythm moni- ≥2 minutes and detected within 12 months after stroke). Sub- toring by implantable or external and wearable monitors and clinical AF was found in 15.3% of patients in the ICM group vs is
JAMA – American Medical Association
Published: Jun 1, 2021
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