Letter from the Editor in Chief

DOI: 10.19102/icrm.2022.13117

MOUSSA MANSOUR, MD, FHRS, FACC,

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Dr. Mansour reports the reception of research grants from Abbott Laboratories, Biosense Webster, Johnson & Johnson, Boston Scientific, Medtronic, Pfizer, Boehringer Ingelheim, and SentreHeart. He is also a consultant for Abbott Laboratories, Biosense Webster, Johnson & Johnson, Boston Scientific, Janssen, Medtronic, Phillips, Novartis, and SentreHeart and reports an equity relationship with EPS Solutions. All aforementioned relationships are in the area of atrial fibrillation; Dr. Mansour additionally reports an equity relationship in the area of ventricular fibrillation with NewPace Ltd.

Dear readers,

The field of ambulatory cardiac monitoring has grown rapidly in the last few years. In particular, many studies have demonstrated the benefit of implantable loop monitors (ILRs) to detect previously undiagnosed atrial fibrillation (AF) in patients with cryptogenic stroke. The CRYSTAL AF study¹ reported that ILRs detected AF in 12% of patients within 6 months of cryptogenic stroke. The PER DIEM study² found that ILRs are superior to prolonged external monitoring for 30 days in detecting AF among patients with ischemic stroke and no prior evidence of the arrhythmia. In the LOOP study,³ ILR screening increased AF detection by 3-fold compared to usual care in individuals with stroke risk factors.

These and other studies have led to greater use of ILRs for AF detection. Technical advances in ILRs have also rendered them more effective in detecting arrhythmias. One such new feature is remote programming, which facilitates the use of ILRs and improves their efficiency, as described in the study by Mahajan et al.⁴ published in this issue of The Journal of Innovations in Cardiac Rhythm Management, which I encourage you to read. We have also been witnessing a rapid expansion in the use of consumer devices for the detection of cardiac arrhythmias. A recent consensus document from the AF-SCREEN International Collaboration⁵ provides a summary of the status of consumer-led screening for AF. However, more studies are needed to demonstrate the sensitivity and specificity of such an approach.

In summary, the positive results of outcome studies coupled with technological advances have catalyzed the rapid expansion of the field of ambulatory monitoring for cardiac arrhythmias, including specifically AF. Though most studies so far have used ILRs, consumer devices have been gaining popularity and may become the primary tool for arrhythmia diagnosis, especially if equipped with artificial intelligence algorithms that improve their specificity.

I hope that you enjoy reading this issue of The Journal of Innovations in Cardiac Rhythm Management and find its content educational. Best wishes to you and your families for a happy holiday season.

Sincerely,

Moussa Mansour, MD, FHRS, FACC

Editor in Chief

The Journal of Innovations in Cardiac Rhythm Management

MMansour@InnovationsInCRM.com

Director, Atrial Fibrillation Program

Jeremy Ruskin and Dan Starks Endowed Chair in Cardiology

Massachusetts General Hospital

Boston, MA 02114

References

1. Sanna T, Diener H-C, Passman RS, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med. 2014;370(26):2478–2486. [CrossRef] [PubMed]
2. Buck BH, Hill MD, Quinn FR, et al. Effect of implantable vs prolonged external electrocardiographic monitoring on atrial fibrillation detection in patients with ischemic stroke: the PER DIEM randomized clinical trial. JAMA. 2021;325(21):2160–2168. [CrossRef] [PubMed]
3. Svendsen JH, Diederichsen SZ, Højberg S, et al. Implantable loop recorder detection of atrial fibrillation to prevent stroke (the LOOP study): a randomised controlled trial. Lancet. 2021;398(10310):1507–1516. [CrossRef] [PubMed]
4. Mahajan D, Frost K, Herrmann K, McGee-Taylor R. Real-world characterization and use of insertable cardiac monitor remote programming. J Innov Cardiac Rhythm Manage. 2022;13(11):5230–5235. [CrossRef]
5. Brandes A, Stavrakis S, Freedman B, et al. Consumer-led screening for atrial fibrillation: frontier review of the AF-SCREEN international collaboration. Circulation. 2022;146(19):1461–1474. [CrossRef] [PubMed]