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Cryptogenic Symptomatic Transient Ischemic AttackPhase 4CRYSTAL-AFNCT00924638

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

A Phase 4 study testing Reveal® XT Insertable Cardiac Monitor in people with Cryptogenic Symptomatic Transient Ischemic Attack and Cryptogenic Ischemic Stroke, run by Medtronic Cardiac Rhythm and Heart Failure at 55 sites in 14 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

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. Read more about this study

Who is it for?
Ages 40 years and older
What is being tested?
Reveal® XT Insertable Cardiac Monitor
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
447 participants
Where
55 sitesin 14 countries
Study dates
Jun 2009to May 2013
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 40 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

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

Who cannot join

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

Trial locations and contacts

55 sites in 14 countries.

55 sites in 14 countries

United States19 sites
  • Northwestern Memorial Hospital

    Chicago, Illinois

  • Ohio Health Research

    Columbus, Ohio

  • Baylor Research Institute

    Dallas, Texas

  • University of Texas - Southwestern Medical Center

    Dallas, Texas

  • South Denver Cardiology / Swedish Medical Center

    Denver, Colorado

  • Iowa Heart / Ruan Neurology

    Des Moines, Iowa

  • Central Bucks Specialists / Doylestown Hospital

    Doylestown, Pennsylvania

  • Sacred Heart Medical Center

    Eugene, Oregon

  • Greenville Hospital System Cardiology/Cardiovascular Research

    Greenville, South Carolina

  • Hackensack University Medical Center

    Hackensack, New Jersey

  • Mid America Heart Institute / St. Lukes Hospital

    Kansas City, Missouri

  • Louisville Cardiology

    Louisville, Kentucky

  • El Camino Hospital

    Mountain View, California

  • St. Thomas Research Institute

    Nashville, Tennessee

  • Thomas Jefferson University

    Philadelphia, Pennsylvania

  • Washington University Medical School

    St Louis, Missouri

  • Cardiology Associates Research, LLC

    Tupelo, Mississippi

  • Forsyth Medical Center

    Winston-Salem, North Carolina

  • Lankenau

    Wynnewood, Pennsylvania

Other trials in United States

Germany10 sites
  • Knappschaftskrankenhaus Bochum

    Bochum

  • Klinikum Coburg GmbH

    Coburg, Bavaria

  • Klinikum Dortmund

    Dortmund

  • Universitätsklinikum Essen

    Essen

  • UMG, Goettingen

    Göttingen

  • Universitätsklinikum der Ernst-Moritz-Arndt-Universität Greifswald

    Greifswald

  • Asklepios Altona

    Hamburg

  • Asklepios Barmbek

    Hamburg

  • Städtisches Klinikum Karlsruhe GmbH

    Karlsruhe

  • Kreiskrankenhaus Rastatt

    Rastatt

Other trials in Germany

Belgium4 sites
  • UZ Antwerpen

    Antwerp

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

    Brussels

  • UZ Leuven

    Leuven

  • Cliniques Universitaires UCL Mont-Godinne

    Mont Godinne

Other trials in Belgium

Italy4 sites
  • Ospedale Misericordia di Grosseto

    Grosseto

  • Ospedale di Imperia

    Imperia

  • Policlinico Universitario Agostino Gemelli

    Rome

  • Ospedale Bolognini

    Seriate

Other trials in Italy

Austria3 sites
  • LKH Universitätsklinikum Graz

    Graz

  • AKH Linz

    Linz

  • Landesklinikum Donauregion Tulln

    Tulln

Other trials in Austria

France3 sites
  • Hôpital Saint André -CHU de Bordeaux

    Bordeaux

  • Clinique Parly II - Centre Hospitalier de Versailles

    Le Chesnay

  • Hôpital de la Timone

    Marseille

Other trials in France

Netherlands3 sites
  • Atrium Medisch Centrum

    Heerlen

  • St. Antonius Ziekenhuis

    Nieuwegein

  • UMC Utrecht

    Utrecht

Other trials in Netherlands

Canada2 sites
  • Hamilton Health Sciences / Hamilton General Hospital

    Hamilton, Ontario

  • CHUS / Hopital Fleurimont

    Sherbrooke, Quebec

Other trials in Canada

Slovakia2 sites
  • NUSCH, a.s. Bratislava

    Bratislava

  • VUSCH Kosice

    Košice

Other trials in Slovakia

Denmark1 site
  • Skejby Hospital

    Aarhus

Other trials in Denmark

Finland1 site
  • Neurology clinic, Turku University Central Hospital

    Turku

Other trials in Finland

Greece1 site
  • Henry Dunant General Hospital

    Athens

Other trials in Greece

Spain1 site
  • Hospital Puerta de Hierro Majadahonda

    Majadahonda

Other trials in Spain

Sweden1 site
  • University Hospital Lund

    Lund

Other trials in Sweden

About this study

Official title: CRYptogenic STroke And underLying AF Trial

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.

Being tested
Reveal® XT Insertable Cardiac Monitor
Keywords
atrial fibrillation, cryptogenic stroke, continuous monitoring, implantable loop recorder, insertable cardiac monitor
Medical subject headings
Ischemic Stroke, Atrial Fibrillation

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Reveal® XT Insertable Cardiac MonitorDevice

    Also called Reveal® XT

    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.

Study groups in NCT00924638
Study groupRoleWhat they receive
Continuous MonitoringActive comparatorContinuous cardiac monitoring by the Reveal® XT Insertable Cardiac Monitor
Receives: Device: Reveal® XT Insertable Cardiac Monitor
Control ArmNo interventionFollow-up at the same frequency, but with no Insertable Cardiac Monitor

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. AF Detection Rate Within 6 Months

    Percentage of subjects with AF detected within 6 months of follow-up

    Measured: 6 months

Secondary outcomes (7)
  1. AF Detection Rate Within 12 Months

    Percentage of subjects with AF detected within 12 months of follow-up

    Measured: 12 months

  2. Incidence of Recurrent Stroke or TIA (Transient Ischemic Attack)

    Percentage of subjects with recurrent stroke or TIA within 12 months of follow-up

    Measured: 12 months

  3. Use of Oral Anticoagulation (OAC) Drugs

    Percentage of subjects who were using OAC drugs at the 12 months follow-up visit

    Measured: 12 months

  4. Use of Antiarrhythmic Drugs

    Percentage of subjects who were using antiarrhythmic drugs at the 12 months follow-up visit

    Measured: 12 months

  5. Health Outcome as Evaluated by EQ-5D Questionnaire

    EQ-5D VAS (visual analog scale) quality of life score, which is a continuous measure of quality of life ranging from 0 (worst) to 100 (perfect health).

    Measured: 12 months

  6. Clinical Disease Burden and Care Pathway

    Incidence of cardiovascular (CV) or stroke/TIA related hospitalizations within 12 months

    Measured: 12 months

  7. Impact of Patient Assistant Use on AF Diagnosis

    AF detection lag (days from AF occurrence to AF diagnosis) characterized by patient assistant (PA) use frequency

    Measured: Follow-up closure

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Jun 2009 (estimated)
  2. Study startJun 2009
  3. Primary completionMay 2013
  4. Study completionMay 2013

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Diagnosis
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
447 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00924638
Sponsor's protocol ID
CRYSTAL-AF
Acronym
CRYSTAL-AF
Status last verified
Jan 2014
First submitted
17 Jun 2009
Last updated
28 Jul 2014
Data monitoring committee
Yes

Publications

  • 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.

    PubMed 16432246
  • 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.

    PubMed 20598970
  • 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.

    PubMed 33984539
  • 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.

    PubMed 33789592
  • 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.

    PubMed 30196791
  • 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.

    PubMed 26763225
  • 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.

    PubMed 26182860
  • 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.

    PubMed 24963567

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Reveal® XT Insertable Cardiac Monitor in people with Cryptogenic Symptomatic Transient Ischemic Attack and Cryptogenic Ischemic Stroke, run by Medtronic Cardiac Rhythm and Heart Failure at 55 sites in 14 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 28 Jul 2014. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 55 sites in United States, Germany, Belgium, Italy, Austria and 9 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 28 Jul 2014). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

AF Detection Rate Within 6 Months (time frame: 6 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00924638, which also lists 8 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Jul 2014.

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