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. 2018 Oct 31;11(3):2078.
doi: 10.4022/jafib.2078. eCollection 2018 Oct-Nov.

Incidence and Predictive Factors of Hidden Atrial Fibrillation Detected by Implantable Loop Recorder After an Embolic Stroke of Undetermined Source

Castro Urda Víctor  1 , Parra Esteban Carolina  1 , Toquero Ramos Jorge  1 , Carneado-Ruiz Joaquín  2 , Sánchez García Manuel  1 , Cobo Marcos Marta  3 , Fernández Villanueva José María  1 , Pham Trung Chinh  1 , Ortega Marcos Javier  4 , Mingo Santos Susana  5 , Jiménez Sánchez Diego  1 , Jiménez Ortiz Carlos  2 , Fernández Lozano Ignacio  1
Affiliations

Incidence and Predictive Factors of Hidden Atrial Fibrillation Detected by Implantable Loop Recorder After an Embolic Stroke of Undetermined Source

Castro Urda Víctor et al. J Atr Fibrillation. .

Abstract

Background: The term embolic stroke of undetermined source (ESUS) has been defined for patients with ischemic strokes, where neither a cardioembolic nor a non-cardiac source can be detected. These patients may have asymptomatic episodes of atrial fibrillation (AF). Prolonged monitoring with implantable loop recorder (ILR) and daily remote interrogation in patients after an ESUS has shown an incidence of AF of about 25%.

Aims: The main objective of this study was to analyze the incidence and predictive factors of atrial fibrillation in patients with ESUS who underwent an ILR implantation.

Methods: It was a single center study. From June 2013 to January 2017 all consecutive patients with an ESUS, who underwent an ILR implantation searching for hidden AF, were included. Possible predictive factors of AF were also analyzed.

Results: 65 patients were included (mean age 65.4±13.8 years, 55.4% males, mean CHA2DS2VASc score 2.3± 1.5). After a median follow-up of 17.1±10.7 months, AF was detected in 19 (29.2%) of patients. Variables associated with AF were: age > 65 years (HR 9.45 (CI 95% 1.25-71.34); p= 0.02), CHA2DS2VASC score≥2 (HR 4.09 (CI 95% 0.93-17.87); p=0,06), left atrial enlargement (HR 2.29 (CI 95% 0.89-5.91); p=0.08) and presence of Supraventricular premature complex(SVC) on 24-hour Holter (HR 4.05 (CI 95% 1.55-10.57); p = 0.004) A cut-point of 0.15% for SVC was identified to predict AF with a sensitivity and specificity of 88.9 and 90%, respectively. A CHA2DS2VASc score<2 and age<65 years showed a negative predictive value to exclude AF of 91.3% and 96%, respectively.

Conclusion: A high incidence of AF was detected in this population. Age >65 years, LA enlargement, CHA2DS2VASC score≥2 and presence of SVC on 24-hour Holter are predictive factors of AF in patients with ESUS.

Keywords: Atrial Fibrillation; CHA2DS2-VASC; Embolic Stroke of Undetermined Source; Implantable Loop Recorder; Left Atrial Enlargement; Supraventricular Premature Complex.

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Figures

Figure 1.
Figure 1.. Reveal LINQ and Reveal XT. Reveal LINQ size is noticeably smaller
Figure 2.
Figure 2.. Atrial fibrillation episode in patient with a Reveal LINQ.
Figure 3.
Figure 3.. Atrial fibrillation-free survival curve. AF: atrial fibrillation
Figure 4.
Figure 4.. Atrial fibrillation-free survival curves according to CHA2DS2VASc score, age, left atrial size and presence of supraventricular premature complex (SVC). AF: atrial fibrillation
Figure 5.
Figure 5.. ROC curve for the percentage of SVC on Holter monitoring. SVC: supraventricular premature complexes.
See this image and copyright information in PMC

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