Clinical implications of delayed insertion of implantable loop recorder: Is it still beneficial when inserted years after a s

Author: Hye Bin Gwag, Nak Gyeong Ko, Mihyeon Jin

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Journal of the Neurological Sciences | Clinical implications of delayed insertion of implantable loop recorder: Is it still beneficial when inserted years after a stroke?

Article Link: https://doi.org/10.1016/j.jns.2026.126051

A recent nationwide cohort study evaluated the optimal timing for inserting an implantable loop recorder (ILR) to detect atrial fibrillation (AF) in 1,509 patients diagnosed with embolic stroke of undetermined source (ESUS). Researchers compared early implantation, occurring within two months of a stroke, to late implantation, occurring more than one year after.

The study found that patients in the early insertion group experienced a significantly higher rate of AF detection compared to the late insertion group. Despite this difference in detection, overall clinical outcomes—including the incidence of recurrent stroke, all-cause mortality, and major bleeding—showed no significant difference between the two timing groups. Additionally, the risk of recurrent stroke and major bleeding did not escalate following AF detection, though a higher risk of mortality was noted. 

The authors concluded that while inserting an ILR earlier appears to be the superior choice for maximizing AF detection, delayed implantation still offers clinical utility for ESUS patients.