Incidence of Silent Atrial Fibrillation in Patients With Clinically Silent Brain Ischemic Lesions — SILENT2  

Silent Stroke Clinical Trial

Official title: Incidence of Silent Atrial Fibrillation in Patients With Clinically Silent Brain Ischemic Lesions (SILENT2)

Status Recruiting

Clinical Trial Summary

Arterial Fibrillation (AF) is well-recognized as a cause for cryptogenic Acute Ischemic Stroke (AIS) and is associated with Silent Brain Infarction (SBI). However, the role of AF in the formation of lesions (SBIs) is less well established than its role in AIS and needs clarification.

The investigators hypothesize that continuous rhythm monitoring will yield a similar incidence of AF diagnosis in patients with SBI as compared to patients with cryptogenic AIS.

The primary objective is to assess the cumulative incidence of AF diagnosis at 24 months in patients with SBI.

Clinical Trial Description

Arterial Fibrillation (AF) is well-recognized as a cause for cryptogenic Acute Ischemic Stroke (AIS) and searched for in clinical practice. However, although AF is associated with Silent Brain Infarction (SBI), its role in the formation of these lesions is less well established and needs clarification. A multitude of clinical, laboratory, echocardiographic and electrocardiographic parameters are associated with AF. Although no single one of these parameters has sufficient specificity to rule-in AF, their combined use may nevertheless help to identify patients with SBI at highest risk for AF. The study is expected to provide evidence that long term monitoring in subjects with SBI yields similar rates of AF as in AIS patients.

Patients aged ≥65 years with a presumably silent brain lesion in a brain magnetic resonance imaging fulfilling inclusion criteria and consenting get a subcutaneous implantation of a cardiac monitor (Reveal LINQ). Data will be directly transferred to the treating physician by the Medtronic MyCareLink Patient Monitor. In case of a relevant arrhythmia, the respective study site will be informed by the staff of Inselspital. Relevant arrhythmias are defined as follows:

• First episode of atrial fibrillation (≥30 seconds)

• Sustained ventricular tachycardia (≥30 seconds)

• Sustained supraventricular tachycardia (≥30 seconds)

• Asystoly of ≥6 seconds duration

• Atrial fibrillation with pause of ≥6 seconds duration

• Higher degree atrioventricular (AV) block (3° AV bloc; 2:1 AV conduction; 2° AV block type Mobitz)

• Sustained bradycardia <30 beats per minute (≥30 seconds) It is the responsibility of the respective study sites to take appropriate actions and inform the patients and treating physicians about relevant findings. The maximal timeframe from data transmission to data analysis is one week and from data transmission to patient notification two weeks.

The expected results of the study would be supportive in introducing long term monitoring to the care pathway in subjects with SBI. Since SBI are more prevalent than AIS and current recommendations very restrictive, this would have a relevant impact on SBI management. ;

Related Conditions & MeSH terms

• Atrial Fibrillation
• Cerebral Infarction
• Fibrillation
• Silent Cerebral Infarct
• Silent Stroke

• NCT number: NCT04449523
• Study type: Observational
• Source: Insel Gruppe AG, University Hospital Bern
• Contact: Laurent Roten, PD Dr. med.
• Phone: +41 31 632 52 63
• Email: laurent.roten@insel.ch
• Status: Recruiting
• Start date: September 8, 2020
• Completion date: December 2025