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. 2020 Feb 24;10(1):3230.
doi: 10.1038/s41598-020-60180-6.

Cryptogenic stroke and atrial fibrillation in a real-world population: the role of insertable cardiac monitors

Maria Vittoria De Angelis  1 , Vincenzo Di Stefano  2 , Raffaella Franciotti  3 , Nanda Furia  4 , Enrico Di Girolamo  4 , Marco Onofrj  3 , Massimiliano Faustino  4
Affiliations

Cryptogenic stroke and atrial fibrillation in a real-world population: the role of insertable cardiac monitors

Maria Vittoria De Angelis et al. Sci Rep. .

Abstract

The incidence of atrial fibrillation (AF) in cryptogenic stroke (CS) patients has been studied in carefully controlled clinical trials, but real-world data are limited. We investigated the incidence of AF in clinical practice among CS patients with an insertable cardiac monitor (ICM) placed for AF detection. Patients with CS admitted to our Stroke Unit were included in the study; they received an ICM and were monitored for up to 3 years for AF detection. All detected AF episodes of at least 120 sec were considered. From March 2016 to March 2019, 58 patients (mean age 68.1 ± 9.3 years, 67% male) received an ICM to detect AF after a CS. No patients were lost to follow-up. AF was detected in 24 patients (41%, AF group mean age 70.8 ± 9.4 years, 62% male) after a mean time of 6 months from ICM (ranging from 2 days to 2 years) and 8 months after CS (ranging from 1 month to 2 years). In these AF patients, anticoagulant treatment was prescribed and nobody had a further stroke. In conclusion, AF episodes were detected via continuous monitoring with ICMs in 41% of implanted CS patients. AF in CS patients is asymptomatic and difficult to diagnose by strategies based on intermittent short-term recordings. Therefore, we suggest that ICMs should be part of daily practice in the evaluation of CS patients.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Kaplan-Meier cumulative curve for all patients when the time passed between the occurrence of AF and the CS is used as the survival time variable. AF, atrial fibrillation; CS, cryptogenic stroke.
See this image and copyright information in PMC

References

    1. Kolominsky-Rabas P, Weber M, Gefeller O, Neundoerfer B, Heuschmann P. Epidemiology of Ischemic Stroke Subtypes According to TOAST Criteria. Stroke. 2001;32:2735–2740. doi: 10.1161/hs1201.100209. - DOI - PubMed
    1. Grau A, et al. Risk Factors, Outcome, and Treatment in Subtypes of Ischemic Stroke: The German Stroke Data Bank. Stroke. 2001;32:2559–2566. doi: 10.1161/hs1101.098524. - DOI - PubMed
    1. Schulz U, Rothwell P. Differences in Vascular Risk Factors Between Etiological Subtypes of Ischemic Stroke. Stroke. 2003;34:2050–2059. doi: 10.1161/01.STR.0000079818.08343.8C. - DOI - PubMed
    1. Adams H, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24:35–41. doi: 10.1161/01.STR.24.1.35. - DOI - PubMed
    1. Hart R, et al. Embolic strokes of undetermined source: the case for a new clinical construct. The Lancet Neurology. 2014;13:429–438. doi: 10.1016/S1474-4422(13)70310-7. - DOI - PubMed