Study of Continuous Cardiac Monitoring to Assess Atrial Fibrillation After Cryptogenic Stroke

NCT ID: NCT00924638

Last Updated: 2014-07-28

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

447 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-06-30

Study Completion Date

2013-05-31

Brief Summary

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The 2006 American Heart Association / American Stroke Association Council on Stroke Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic recommended that patients with cryptogenic stroke take antithrombotic drugs (i.e. aspirin) in order to prevent a second stroke. When a stroke patient is found to have atrial fibrillation (AF), the guidelines recommend oral anticoagulation due to its superior efficacy over aspirin for stroke prevention. Physicians can best optimize the use of medicines only if they can precisely and correctly diagnose a patient's AF. The purpose of this study is to evaluate the time to first AF by 6 months' continuous rhythm monitoring versus control treatment in subjects with a recent cryptogenic stroke or Transient Ischemic Attack (TIA) without history of AF.

Detailed Description

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Conditions

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Cryptogenic Symptomatic Transient Ischemic Attack Cryptogenic Ischemic Stroke

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Continuous Monitoring

Continuous cardiac monitoring by the Reveal® XT Insertable Cardiac Monitor

Group Type ACTIVE_COMPARATOR

Reveal® XT Insertable Cardiac Monitor

Intervention Type DEVICE

The Insertable Cardiac Monitor is implanted under the skin in the region of the thorax. It continuously monitors the heart's electrical activity for up to three years. ECG data are stored when the device detects a cardiac arrhythmia.

Control Arm

Follow-up at the same frequency, but with no Insertable Cardiac Monitor

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Reveal® XT Insertable Cardiac Monitor

The Insertable Cardiac Monitor is implanted under the skin in the region of the thorax. It continuously monitors the heart's electrical activity for up to three years. ECG data are stored when the device detects a cardiac arrhythmia.

Intervention Type DEVICE

Other Intervention Names

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Reveal® XT

Eligibility Criteria

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Inclusion Criteria

1. Recent cryptogenic symptomatic transient ischemic attack (TIA) or cryptogenic ischemic stroke.

Exclusion Criteria

1. Known etiology of TIA or stroke.
2. Untreated hyperthyroidism.
3. Myocardial infarction less than 1 month prior to stroke or TIA.
4. Coronary bypass grafting less than 1 month prior to stroke or TIA.
5. Valvular disease requiring immediate surgical intervention.
6. History of AF or atrial flutter.
7. Patent Foramen Ovale (PFO) and PFO is or was an indication to start oral anticoagulation (OAC).
8. Permanent indication for OAC at enrollment.
9. Permanent contra-indication for OAC.
10. Included in another clinical trial.
11. Life expectancy less than 1 year.
12. Pregnant.
13. Indicated for Implantable Pulse Generator (IPG), Implantable Cardioverter-Defibrillator (ICD), Cardiac Resynchronization Therapy (CRT) or an implantable hemodynamic monitoring system.
14. Not fit, unable or unwilling to follow the required procedures of the protocol.
Minimum Eligible Age

40 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Medtronic Cardiac Rhythm and Heart Failure

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Johannes Brachmann, MD

Role: PRINCIPAL_INVESTIGATOR

Klinikum Coburg, Germany

Tommaso Sanna, MD

Role: PRINCIPAL_INVESTIGATOR

Catholic University, Italy

Hans Christoph Diener, MD

Role: PRINCIPAL_INVESTIGATOR

Klinik für Neurologie, Essen, Germany

Carlos Morillo, MD

Role: PRINCIPAL_INVESTIGATOR

McMaster Clinic, Hamilton, Ontario, Canada

Richard Bernstein, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Davee Department of Neurology, Chicago, IL USA

Vincenzo Di Lazzaro, MD

Role: PRINCIPAL_INVESTIGATOR

Catholic University Rome, Rome Italy

Rod Passman, MD

Role: PRINCIPAL_INVESTIGATOR

Northwestern Memorial Hospital, Chicago, IL USA

Marilyn Rymer, MD

Role: PRINCIPAL_INVESTIGATOR

St. Lukes Hospital of Kansas City, Kansas City, MI USA

Locations

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El Camino Hospital

Mountain View, California, United States

Site Status

South Denver Cardiology / Swedish Medical Center

Denver, Colorado, United States

Site Status

Northwestern Memorial Hospital

Chicago, Illinois, United States

Site Status

Iowa Heart / Ruan Neurology

Des Moines, Iowa, United States

Site Status

Louisville Cardiology

Louisville, Kentucky, United States

Site Status

Cardiology Associates Research, LLC

Tupelo, Mississippi, United States

Site Status

Mid America Heart Institute / St. Lukes Hospital

Kansas City, Missouri, United States

Site Status

Washington University Medical School

St Louis, Missouri, United States

Site Status

Hackensack University Medical Center

Hackensack, New Jersey, United States

Site Status

Forsyth Medical Center

Winston-Salem, North Carolina, United States

Site Status

Ohio Health Research

Columbus, Ohio, United States

Site Status

Sacred Heart Medical Center

Eugene, Oregon, United States

Site Status

Central Bucks Specialists / Doylestown Hospital

Doylestown, Pennsylvania, United States

Site Status

Thomas Jefferson University

Philadelphia, Pennsylvania, United States

Site Status

Lankenau

Wynnewood, Pennsylvania, United States

Site Status

Greenville Hospital System Cardiology/Cardiovascular Research

Greenville, South Carolina, United States

Site Status

St. Thomas Research Institute

Nashville, Tennessee, United States

Site Status

Baylor Research Institute

Dallas, Texas, United States

Site Status

University of Texas - Southwestern Medical Center

Dallas, Texas, United States

Site Status

LKH Universitätsklinikum Graz

Graz, , Austria

Site Status

AKH Linz

Linz, , Austria

Site Status

Landesklinikum Donauregion Tulln

Tulln, , Austria

Site Status

UZ Antwerpen

Antwerp, , Belgium

Site Status

Brussels Heart Center (St. Lean - St. Pierre)

Brussels, , Belgium

Site Status

UZ Leuven

Leuven, , Belgium

Site Status

Cliniques Universitaires UCL Mont-Godinne

Mont Godinne, , Belgium

Site Status

Hamilton Health Sciences / Hamilton General Hospital

Hamilton, Ontario, Canada

Site Status

CHUS / Hopital Fleurimont

Sherbrooke, Quebec, Canada

Site Status

Skejby Hospital

Aarhus, , Denmark

Site Status

Neurology clinic, Turku University Central Hospital

Turku, , Finland

Site Status

Hôpital Saint André -CHU de Bordeaux

Bordeaux, , France

Site Status

Clinique Parly II - Centre Hospitalier de Versailles

Le Chesnay, , France

Site Status

Hôpital de la Timone

Marseille, , France

Site Status

Klinikum Coburg GmbH

Coburg, Bavaria, Germany

Site Status

Knappschaftskrankenhaus Bochum

Bochum, , Germany

Site Status

Klinikum Dortmund

Dortmund, , Germany

Site Status

Universitätsklinikum Essen

Essen, , Germany

Site Status

UMG, Goettingen

Göttingen, , Germany

Site Status

Universitätsklinikum der Ernst-Moritz-Arndt-Universität Greifswald

Greifswald, , Germany

Site Status

Asklepios Altona

Hamburg, , Germany

Site Status

Asklepios Barmbek

Hamburg, , Germany

Site Status

Städtisches Klinikum Karlsruhe GmbH

Karlsruhe, , Germany

Site Status

Kreiskrankenhaus Rastatt

Rastatt, , Germany

Site Status

Henry Dunant General Hospital

Athens, , Greece

Site Status

Ospedale Misericordia di Grosseto

Grosseto, , Italy

Site Status

Ospedale di Imperia

Imperia, , Italy

Site Status

Policlinico Universitario Agostino Gemelli

Rome, , Italy

Site Status

Ospedale Bolognini

Seriate, , Italy

Site Status

Atrium Medisch Centrum

Heerlen, , Netherlands

Site Status

St. Antonius Ziekenhuis

Nieuwegein, , Netherlands

Site Status

UMC Utrecht

Utrecht, , Netherlands

Site Status

NUSCH, a.s. Bratislava

Bratislava, , Slovakia

Site Status

VUSCH Kosice

Košice, , Slovakia

Site Status

Hospital Puerta de Hierro Majadahonda

Majadahonda, , Spain

Site Status

University Hospital Lund

Lund, , Sweden

Site Status

Countries

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United States Austria Belgium Canada Denmark Finland France Germany Greece Italy Netherlands Slovakia Spain Sweden

References

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Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, Goldstein LB, Gorelick P, Halperin J, Harbaugh R, Johnston SC, Katzan I, Kelly-Hayes M, Kenton EJ, Marks M, Schwamm LH, Tomsick T; American Heart Association; American Stroke Association Council on Stroke; Council on Cardiovascular Radiology and Intervention; American Academy of Neurology. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Stroke. 2006 Feb;37(2):577-617. doi: 10.1161/01.STR.0000199147.30016.74.

Reference Type BACKGROUND
PMID: 16432246 (View on PubMed)

Sinha AM, Diener HC, Morillo CA, Sanna T, Bernstein RA, Di Lazzaro V, Passman R, Beckers F, Brachmann J. Cryptogenic Stroke and underlying Atrial Fibrillation (CRYSTAL AF): design and rationale. Am Heart J. 2010 Jul;160(1):36-41.e1. doi: 10.1016/j.ahj.2010.03.032.

Reference Type BACKGROUND
PMID: 20598970 (View on PubMed)

Kaffenberger T, Bernhardt J, Koehler JL, Ziegler PD, Thijs VN. Ambulatory activity in stroke survivors associated with functional outcome and quality of life: An observational cohort study. Ann Phys Rehabil Med. 2022 Mar;65(2):101540. doi: 10.1016/j.rehab.2021.101540. Epub 2021 Nov 13.

Reference Type DERIVED
PMID: 33984539 (View on PubMed)

Witte KK, Tsivgoulis G, Reynolds MR, Tsintzos SI, Eggington S, Ismyrloglou E, Lyon J, Huynh M, Egea M, de Brouwer B, Ziegler PD, Franco N, Joglekar R, Rosemas SC, Liu S, Thijs V. Burden of oral anticoagulation in embolic stroke of undetermined source without atrial fibrillation. BMC Cardiovasc Disord. 2021 Mar 31;21(1):160. doi: 10.1186/s12872-021-01967-x.

Reference Type DERIVED
PMID: 33789592 (View on PubMed)

Verma N, Ziegler PD, Liu S, Passman RS. Incidence of atrial fibrillation among patients with an embolic stroke of undetermined source: Insights from insertable cardiac monitors. Int J Stroke. 2019 Feb;14(2):146-153. doi: 10.1177/1747493018798554. Epub 2018 Sep 10.

Reference Type DERIVED
PMID: 30196791 (View on PubMed)

Brachmann J, Morillo CA, Sanna T, Di Lazzaro V, Diener HC, Bernstein RA, Rymer M, Ziegler PD, Liu S, Passman RS. Uncovering Atrial Fibrillation Beyond Short-Term Monitoring in Cryptogenic Stroke Patients: Three-Year Results From the Cryptogenic Stroke and Underlying Atrial Fibrillation Trial. Circ Arrhythm Electrophysiol. 2016 Jan;9(1):e003333. doi: 10.1161/CIRCEP.115.003333.

Reference Type DERIVED
PMID: 26763225 (View on PubMed)

Bernstein RA, Di Lazzaro V, Rymer MM, Passman RS, Brachmann J, Morillo CA, Sanna T, Thijs V, Rogers T, Liu S, Ziegler PD, Diener HC. Infarct Topography and Detection of Atrial Fibrillation in Cryptogenic Stroke: Results from CRYSTAL AF. Cerebrovasc Dis. 2015;40(1-2):91-6. doi: 10.1159/000437018. Epub 2015 Jul 11.

Reference Type DERIVED
PMID: 26182860 (View on PubMed)

Sanna T, Diener HC, Passman RS, Di Lazzaro V, Bernstein RA, Morillo CA, Rymer MM, Thijs V, Rogers T, Beckers F, Lindborg K, Brachmann J; CRYSTAL AF Investigators. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med. 2014 Jun 26;370(26):2478-86. doi: 10.1056/NEJMoa1313600.

Reference Type DERIVED
PMID: 24963567 (View on PubMed)

Other Identifiers

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CRYSTAL-AF

Identifier Type: -

Identifier Source: org_study_id

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