Intensive heart rhythm monitoring to decrease ischemic stroke and systemic embolism—the Find-AF 2 study—rationale and design - 11/10/23
Doi : 10.1016/j.ahj.2023.06.016
Tobias Uhe, MD a, #, Katrin Wasser, MD b, #, Mark Weber-Krüger, MD c, #, Wolf-Rüdiger Schäbitz, MD d, Martin Köhrmann, MD e, Johannes Brachmann, MD f, Ulrich Laufs, MD a, Martin Dichgans, MD g, h, i, Götz Gelbrich, PhD j, k, David Petroff, PhD l, Christiane Prettin, PhD l, Dominik Michalski, MD m, Andrea Kraft, MD n, Thorleif Etgen, MD o, Peter D. Schellinger, MD p, Hassan Soda, MD q, Florian Bethke, MD r, Michael Ertl, MD s, Bernd Kallmünzer, MD t, Martin Grond, MD u, Katharina Althaus, MD v, Gerhard F. Hamann, MD w, Meinhard Mende, PhD l, Marcus Wagner, PhD l, Sonja Gröschel, MD x, Timo Uphaus, MD x, Klaus Gröschel, MD x, †, Rolf Wachter, MD a, y, z, †, ⁎ 
on behalf of the
on behalf of the
Find-AF 2 study group
Rolf Wachter , Klaus Gröschel, Katrin Wasser, Tobias Uhe , Wolf-Rüdiger Schäbitz, Martin Köhrmann, Martin Dichgans, Sonja Gröschel, Timo Uphaus, Marianne Hahn, Frederic Zuhorn, Leonard Wulff, Jorge Plümer, Lena Kok, Marcel Janz, Alkisti Kitsiou, Julian Gehmeyr, Alhuda Dabbagh, Charlotte Huber, Johann Pelz, Katja Wartenberg, Dominik Michalski, Mirko Seidel, Oscar Flissakowski, Anna Goschenhofer, Rabia-Basari Hussain, Ina Kim, Stephan Kinze, Christian Kroneberger, Michale Lingnau, Dennis Lischewski, Florian Muhn, Witold Rogge, Miriam Schieffer, Anuscheh Setayesh-Roonizi, Paul Sparenberg, Jill Marie Schertel, Peter Ringleb, Jan Purrucker, Anne Berberich, Miriam Heyse, Matthias Ungerer, Gregor Bauer, Christine Reichardt, Thorleif Etgen, Bernhard Ebel, Dragana Milanković-Eberl, Olav Schwarte, Constanze Höcherl, Eric-Manuel Asch, Luisa Bojtschuk, Maximilian Frey, Tomas Dlouhy, Michael Ertl, Philipp Patrick Zickler, Barbara Beier, Lino-Dominic Braadt, Inessa Gabrielyan, Pawel Kermer, Matthias Kaste, Ahmed Anter, Corina Stirbulescu, Nataliia Meleshchenco, Friederike Burgholte, Claus Lüers, Thorsten Steiner, Cierpinski, Lichti Mari-Carmen, Florian Bethke, Lars Bonowski, Hassan Abou Eid, Esteban Vajda-Medina, Mareike Probst, Hisham Essa, Benedikt Frank, Benjamin Stolte, Lennart Milles, Hassan Soda, Erich Hiermann, Renate Weinhardt Alexandra Rascher, Marius Stan, Stefan Kääb, Lars Kellert, Konstantinos Dimitriadis, Anna Kopczak, Bettina Küster, Moritz Sinner, Ignaz Steiger, Maria Kaffe, Sebastian Clauß, Daniel Janowitz, Raffael Thaler, Peter Schellinger, Jörg Glahn, Jan Schubert, Simone Jenniges, Silke Markmann-Boenke, Anne-Sophie Putzer, Michael Schwarze Vera Straeten, Marcus Wiemer, Bernd Kallmünzer, Kosmas Macha, David Haupenthal, Stefanie Balk, Clara-Sophie Kossel, Georg Häusler, Dominik Lehrieder, Peter Cidlinsky, Christian Hametner, Christine Vogl, Thomas Fischer, Moritz Huttelmaier, Octavian Maniuc Peter Nordbeck, Albrecht von Hardenberg, Martin Jünemann, Tobias Braun, Maxime Viard, Stefan Gerner, AlHaj Omar, Sonja Genau, Linus Olbricht, Matthias Wassenberg, Niklas Langguth, Christian Fräbel, Romy Baumgart, Love-Preet Kalra, Norma Diel, Frank Hoffmann, Andrea Kraft, Bettine Schönmuth, Anja Giebler, Lorenz Weber, Martin Grond, Jan Birringer, Sandra Lichte-Schneider, Daniela Hütwohl, Lars Udo Krause, Martina Petersen, Katharina Althaus, Konstantin Kirchmeier, Liubov Novikova, Susanne Müller, Sebastian Schellong, Mirko Brudzinski, Ulrich Gerk, Holger Palisch, Frank R. Heinzel, Jana Fett, Avinash Suntha, Katja Burian, Bettina Schmitz, Anna Gutwinski, Veronika Angermüller, Tameem Alhammoud, Hüsniye Cakiroglu, Ullrich Bach, Darius Nabavi, Jens Offermann, Olaf Crome, Boris Dimitrijeski, Carsten Meincke, Gerhard Hamann, Burkhard Alber, Robert Müller, Lars-Peder Pallesen, Volker Pütz, Christian Hartmann, Jörg Berrouschot, Anett Stoll, Janina Keilitz, Dietrich Klunk, Roman Voigt, Andreas Kastrup, Andreas Schröter, Johannes Schmucker, Waltraud Pfeilschifter, Christoffer Krämer, Milena Wiemers, Micha Simon, Alexander Finke, Christian Weiß, Carsten Hobohm, Katrin Naupold, Karen Bley-Renning, Sabrina Winter, Sven Poli, Annerose Mengel, Khouloud Poli, Alexandra Gómez Expósito, Joshua Mbroh, Maria Tieck, Michael Rosenkranz, Stefan Boskamp, Nicolas Ritter, Lena Seibel, Christian Schöps, Rebecca Ketzler, Herbert Nägele, Karsten Sydow, Natalia Kurka, Jan Hendrik Schäfer, Daniel Charisse, Katharina Gruber, Konstantin Kohlhase, Franziska Lieschke, Felix Operhalski, Alexander Seiler, Gabor Petzold, Felix Jürgen Bode, Sebastian Stösser, Julius Meißner, Taraneh Ebrahimi, Julia Nordsiek, Niklas Beckonert, Karin Weissenborn, Gerrit Maximilian Große, Hans Worthmann, Ann-Katrin Hennemann, Svenja Jochmann, Julius Gründahl, Jana Al-Ayoubi, Johanna Ernst, Oliver Bähr, Herbert Gruber, Sonka Benesch, Thomas Pollinger, Nawar Alachkar, Sonia Busch, Steffi Butz, Mathias Forkmann, Christian Mahnkopf, Thomas Mischke, Steffen Schnupp, Götz Thomalla, Milani Deb-Chatterji, Bastian Cheng, Mathias Gelderblom, Julia Hoppe, Märit Jensen, Maximilian Schell, Eckhard Schlemm, Lars Marquardt, Haiko Kazarians, Pia Franziska Rheingans, Kai Hötzer, Dietmar Rose, Tobias Neumann-Haefelin, Jörg Berthel, Lirim Alijaj, Joachim Krug, Margit Niethammer, Géza-Attila Szöllösi, Marc Obermann, Nicoletta Adochitei, Herwig Strik, Arne Lenz, Frank Steigerwald, Jörg Müller, Martin Honermann, Marian Christoph Burgstaller, Rainer Kollmar, Maryam Rashid, Ahmad Ajaz Ganai, Ossendorf, Majda Saric, Karl-Heinz Tischer, Adela Toluli, Frank Arne Wollenweber, Laya Rahban, Thais Portugal Silva, Miri Lee, Matthias Julius Grosch, Jens Minnerup, Jan Liman, Martin Nückel, Magdalena Böhm
a Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
b Department of Neurology, University of Göttingen Medical Center, Göttingen, Germany
c Department of Palliative Medicine, University of Göttingen Medical Center, Göttingen, Germany
d Department of Neurology, EvKB-Bethel University Hospital, Bielefeld, Germany
e Department of Neurology, University of Essen, Essen, Germany
f Department of Cardiology, Klinikum Coburg, Coburg, Germany
g Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
h German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany
i Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
j Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
k Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany
l Clinical Trial Centre (ZKS) Leipzig, Leipzig University, Leipzig, Germany
m Department of Neurology, University Hospital Leipzig, Leipzig, Germany
n Department of Neurology, Hospital Martha-Maria, Halle, Germany
o Department of Neurology, Klinikum Traunstein, Traunstein, Germany
p Department of Neurology and Neurogeriatrics, University Hospital Minden, Minden, Germany
q Department of Neurology, Rhön Hospital, Bad Neustadt, Germany
r Department of Neurology, Ibbenbüren Hospital, Ibbenbüren, Germany
s Clinic for Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
t Department of Neurology, University Hospital Erlangen, Erlangen, Germany
u Department of Neurology, Siegen Hospital, Siegen, Germany
v Department of Neurology, University Hospital Ulm, Ulm, Germany
w Clinic for Neurology and Neurorehabilitation, Bezirkskrankenhaus Günzburg, Günzburg, Germany
x Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
y Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
z DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
⁎Reprint requests: Rolf Wachter, MD, Department of Cardiology, University Hospital Leipzig, Liebigstraße 20, Haus 4, Leipzig 04103, Germany.Department of CardiologyUniversity Hospital LeipzigLiebigstraße 20, Haus 4Leipzig04103Germany
Résumé |
Background |
Atrial fibrillation (AF) is one of the most frequent causes of stroke. Several randomized trials have shown that prolonged monitoring increases the detection of AF, but the effect on reducing recurrent cardioembolism, ie, ischemic stroke and systemic embolism, remains unknown. We aim to evaluate whether a risk-adapted, intensified heart rhythm monitoring with consequent guideline conform treatment, which implies initiation of oral anticoagulation (OAC), leads to a reduction of recurrent cardioembolism.
Methods |
Find-AF 2 is a randomized, controlled, open-label parallel multicenter trial with blinded endpoint assessment. 5,200 patients ≥ 60 years of age with symptomatic ischemic stroke within the last 30 days and without known AF will be included at 52 study centers with a specialized stroke unit in Germany. Patients without AF in an additional 24-hour Holter ECG after the qualifying event will be randomized in a 1:1 fashion to either enhanced, prolonged and intensified ECG-monitoring (intervention arm) or standard of care monitoring (control arm). In the intervention arm, patients with a high risk of underlying AF will receive continuous rhythm monitoring using an implantable cardiac monitor (ICM) whereas those without high risk of underlying AF will receive repeated 7-day Holter ECGs. The duration of rhythm monitoring within the control arm is up to the discretion of the participating centers and is allowed for up to 7 days. Patients will be followed for at least 24 months. The primary efficacy endpoint is the time until recurrent ischemic stroke or systemic embolism occur.
Conclusions |
The Find-AF 2 trial aims to demonstrate that enhanced, prolonged and intensified rhythm monitoring results in a more effective prevention of recurrent ischemic stroke and systemic embolism compared to usual care.
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| Members of the Find-AF 2 study group: Rolf Wachter, Klaus Gröschel, Katrin Wasser, Tobias Uhe, Wolf-Rüdiger Schäbitz, Martin Köhrmann, Martin Dichgans, Sonja Gröschel, Timo Uphaus, Marianne Hahn, Frederic Zuhorn, Leonard Wulff, Jorge Plümer, Lena Kok, Marcel Janz, Alkisti Kitsiou, Julian Gehmeyr, Alhuda Dabbagh, Charlotte Huber, Johann Pelz, Katja Wartenberg, Dominik Michalski, Mirko Seidel, Oscar Flissakowski, Anna Goschenhofer, Rabia-Basari Hussain, Ina Kim, Stephan Kinze, Christian Kroneberger, Michale Lingnau, Dennis Lischewski, Florian Muhn, Witold Rogge, Miriam Schieffer, Anuscheh Setayesh-Roonizi, Paul Sparenberg, Jill Marie Schertel, Peter Ringleb, Jan Purrucker, Anne Berberich, Miriam Heyse, Matthias Ungerer, Gregor Bauer, Christine Reichardt, Thorleif Etgen, Bernhard Ebel, Dragana Milanković-Eberl, Olav Schwarte, Constanze Höcherl, Eric-Manuel Asch, Luisa Bojtschuk, Maximilian Frey, Tomas Dlouhy, Michael Ertl, Philipp Patrick Zickler, Barbara Beier, Lino-Dominic Braadt, Inessa Gabrielyan, Pawel Kermer, Matthias Kaste, Ahmed Anter, Corina Stirbulescu, Nataliia Meleshchenco, Friederike Burgholte, Claus Lüers, Thorsten Steiner, Cierpinski, Lichti Mari-Carmen, Florian Bethke, Lars Bonowski, Hassan Abou Eid, Esteban Vajda-Medina, Mareike Probst, Hisham Essa, Benedikt Frank, Benjamin Stolte, Lennart Milles, Hassan Soda, Erich Hiermann, Renate Weinhardt Alexandra Rascher, Marius Stan, Stefan Kääb, Lars Kellert, Konstantinos Dimitriadis, Anna Kopczak, Bettina Küster, Moritz Sinner, Ignaz Steiger, Maria Kaffe, Sebastian Clauß, Daniel Janowitz, Raffael Thaler, Peter Schellinger, Jörg Glahn, Jan Schubert, Simone Jenniges, Silke Markmann-Boenke, Anne-Sophie Putzer, Michael Schwarze Vera Straeten, Marcus Wiemer, Bernd Kallmünzer, Kosmas Macha, David Haupenthal, Stefanie Balk, Clara-Sophie Kossel, Georg Häusler, Dominik Lehrieder, Peter Cidlinsky, Christian Hametner, Christine Vogl, Thomas Fischer, Moritz Huttelmaier, Octavian Maniuc Peter Nordbeck, Albrecht von Hardenberg, Martin Jünemann, Tobias Braun, Maxime Viard, Stefan Gerner, Omar AlHaj Omar, Sonja Genau, Linus Olbricht, Matthias Wassenberg, Niklas Langguth, Christian Fräbel, Romy Baumgart, Love-Preet Kalra, Norma Diel, Frank Hoffmann, Andrea Kraft, Bettine Schönmuth, Anja Giebler, Lorenz Weber, Martin Grond, Jan Birringer, Sandra Lichte-Schneider, Daniela Hütwohl, Lars Udo Krause, Martina Petersen, Katharina Althaus, Konstantin Kirchmeier, Liubov Novikova, Susanne Müller, Sebastian Schellong, Mirko Brudzinski, Ulrich Gerk, Holger Palisch, Frank R. Heinzel, Jana Fett, Avinash Suntha, Katja Burian, Bettina Schmitz, Anna Gutwinski, Veronika Angermüller, Tameem Alhammoud, Hüsniye Cakiroglu, Ullrich Bach, Darius Nabavi, Jens Offermann, Olaf Crome, Boris Dimitrijeski, Carsten Meincke, Gerhard Hamann, Burkhard Alber, Robert Müller, Lars-Peder Pallesen, Volker Pütz, Christian Hartmann, Jörg Berrouschot, Anett Stoll, Janina Keilitz, Dietrich Klunk, Roman Voigt, Andreas Kastrup, Andreas Schröter, Johannes Schmucker, Waltraud Pfeilschifter, Christoffer Krämer, Milena Wiemers, Micha Simon, Alexander Finke, Christian Weiß, Carsten Hobohm, Katrin Naupold, Karen Bley-Renning, Sabrina Winter, Sven Poli, Annerose Mengel, Khouloud Poli, Alexandra Gómez Expósito, Joshua Mbroh, Maria Tieck, Michael Rosenkranz, Stefan Boskamp, Nicolas Ritter, Lena Seibel, Christian Schöps, Rebecca Ketzler, Herbert Nägele, Karsten Sydow, Natalia Kurka, Jan Hendrik Schäfer, Daniel Charisse, Katharina Gruber, Konstantin Kohlhase, Franziska Lieschke, Felix Operhalski, Alexander Seiler, Gabor Petzold, Felix Jürgen Bode, Sebastian Stösser, Julius Meißner, Taraneh Ebrahimi, Julia Nordsiek, Niklas Beckonert, Karin Weissenborn, Gerrit Maximilian Große, Hans Worthmann, Ann-Katrin Hennemann, Svenja Jochmann, Julius Gründahl, Jana Al-Ayoubi, Johanna Ernst, Oliver Bähr, Herbert Gruber, Sonka Benesch, Thomas Pollinger, Nawar Alachkar, Sonia Busch, Steffi Butz, Mathias Forkmann, Christian Mahnkopf, Thomas Mischke, Steffen Schnupp, Götz Thomalla, Milani Deb-Chatterji, Bastian Cheng, Mathias Gelderblom, Julia Hoppe, Märit Jensen, Maximilian Schell, Eckhard Schlemm, Lars Marquardt, Haiko Kazarians, Pia Franziska Rheingans, Kai Hötzer, Dietmar Rose, Tobias Neumann-Haefelin, Jörg Berthel, Lirim Alijaj, Joachim Krug, Margit Niethammer,Géza-Attila Szöllösi, Marc Obermann, Nicoletta Adochitei, Herwig Strik, Arne Lenz, Frank Steigerwald, Jörg Müller, Martin Honermann, Marian Christoph Burgstaller, Rainer Kollmar, Maryam Rashid, Ahmad Ajaz Ganai, Ossendorf, Majda Saric, Karl-Heinz Tischer, Adela Toluli, Frank Arne Wollenweber, Laya Rahban, Thais Portugal Silva, Miri Lee, Matthias Julius Grosch, Jens Minnerup, Jan Liman, Martin Nückel, Magdalena Böhm. |
© 2023
The Author(s). Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 265
P. 66-76 - novembre 2023 Retour au numéro
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