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Multicenter Study
. 2025 Jun;32(6):e70251.
doi: 10.1111/ene.70251.

Long-Term Detection of Subclinical Atrial Fibrillation in Cryptogenic Stroke Patients With Insertable Cardiac Monitors

Leonardo Pantoni  1   2   3 , Francesco Mele  3 , Francesca Pescini  4 , Martina Rafanelli  5 , Cecilia Zivelonghi  6 , Luca Tomasi  7 , Giacomo Mugnai  7 , Caterina Tomaselli  8 , Alfredo Petrone  9 , Alessandro Adami  10 , Giulio Molon  11 , Pasquale Crea  12 , Paolino La Spina  13 , Giuseppe Carullo  14 , Franco Galati  15 , Sebastiano Lumera  16 , Antonello Giordano  17 , Giulia Matteucci  5 , Giuseppe Scopelliti  3 , Giovanni Forleo  18 , Andrea Ungar  5
Affiliations
Multicenter Study

Long-Term Detection of Subclinical Atrial Fibrillation in Cryptogenic Stroke Patients With Insertable Cardiac Monitors

Leonardo Pantoni et al. Eur J Neurol. 2025 Jun.

Abstract

Background: Long-term continuous monitoring with insertable cardiac monitor (ICM) is recommended after cryptogenic stroke (CS) by current guidelines to detect subclinical atrial fibrillation (SCAF). However, long-term real-world data on ICM-SCAF detection and ensuing therapy are limited. The aim of this study was to assess long-term SCAF detection rate in a large cohort of CS patients with ICM.

Methods: Data of consecutive CS patients receiving ICM from September 2016 to February 2024 in 20 Italian centers were collected. Patients were followed with remote and outpatient follow-up according to clinical practice. SCAF was diagnosed if a device-detected SCAF daily burden ≥ 5 min was confirmed by a cardiologist.

Results: Seven hundred and eighty-nine CS patients with ICM (mean age 69.3 ± 11.7 years, 40.3% females, 79.0% CHA2DS2-VASc score ≥ 4) were monitored for a mean of 27.3 (IQR:14.2-42.5) months after index stroke. SCAF was diagnosed in 229 (29.0%) patients, with a cumulative detection rate of 37.0% (IQR: 32.9%-41.5%) 48 months after the stroke, and was asymptomatic in 198 (86.5%). Sixty-eight (29.7%) patients had one or more days with a 24-h SCAF burden. Median time from index stroke to SCAF diagnosis was 6.9 (IQR: 2.1-17.0) months. After SCAF diagnosis, anticoagulants were prescribed to 210 (95.9%) patients out of 219 not already assuming them at baseline. CHA2DS2-VASc ≥ 5, anterior circulation stroke, and cortical lesions were independent predictors of SCAF diagnosis.

Conclusions: This multicenter real-world project confirmed that ICM allows the detection of SCAF in one third of CS patients 48 months after the stroke, leading to anticoagulation in most of them.

Keywords: atrial fibrillation; cardiac remote monitoring; cryptogenic stroke; insertable cardiac monitor; stroke.

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Conflict of interest statement

L.P. serves on the editorial board of Neurology, Cerebrovascular Diseases, European Stroke Journal, Cerebral Circulation Cognition and Behavior, and is associate editor of Neurological Sciences. He has received consultation fees from PIAM, Medtronic, and Amicus. G.M. received modest consultancy fees and speaker's fees from Medtronic and Boston Scientific. A.U. received modest consultancy fees and speaker's fees from Medtronic. No other declare conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Time to first detection of SCAF from ICM implantation and from the index score. ICM, Insertable cardiac monitor; SCAF, Subclinical atrial fibrillation. The survival curves have been reported until the subjects at risk were at least the 15% of the initial set.
FIGURE 2
FIGURE 2
Patient distribution according to their maximum SCAF daily burden.
See this image and copyright information in PMC

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