Immediate implantable loop recorder implantation for detecting atrial fibrillation in cryptogenic stroke

Introduction: Atrial fibrillation (AF) is suspected as the main cause of stroke in the majority of patients presenting with cryptogenic stroke (CS). Implantable loop recorders (ILR's) are indicated for detecting AF in these patients. The short term (<1 month) and long-term AF detection rates in patients inserted with an ILR immediately after CS is reported. Secondly, we compare the safety of nurse led vs physician led ILR implantation in these patients. Methods: This is a ret-rospective review of all patients who underwent inpatient ILR implantation (Med-tronic Linq) between May 2020 and May 2022 at East Sussex Healthcare NHS trust. All patients were remotely monitored via the FOCUSONTM monitoring and triage service. Results: A total of 186 subjects were included in the study and were fol-lowed up for a mean period of 363.0 +/-222.6 days. The mean time between stroke and ILR was 7.0 +/-5.5 days. The mean time between referral and ILR was 1.0 +/-2.0 days. AF was detected in 25 (13.4%) patients. During the first 30 days of monitoring, AF was detected in 9 (4.8%) patients. The number of ILR implants performed by the specialist nurse was 107 (57.5%). There was no significant difference in the major complication rate (requiring device removal) between nurse and physician led implant (1 (0.95%) vs 0 (0%), p value = 0.389). Conclusion: Inpatient ILR for cryptogenic stroke is feasible. The rate of AF detection in the first month post CS is 4.8% however, more AF was detected up to one year post implant, suggesting rationale for proceeding directly to ILR implant in these patients before discharge to not delay treatment. A nurse led ser-vice is also viable with no significant difference in the major complication rate com-pared to physician led implants.