Abstract
Objective
To determine the prevalence and risk factors for paroxysmal atrial fibrillation (PAF) diagnosis in non- cryptogenic ischemic stroke (CIS) patients.
Methods
In this pilot-prospective cohort study of non-CIS patients from September 2014 to September 2017, 53 patients were enrolled. 51/53 patients were implanted within 10 days of stroke onset with the Reveal LINQ insertable cardiac monitor and monitored until PAF detection or a minimum of 12 months. Inclusion required diagnosis of a non-AF stroke etiology, age ≥ 40, and either a virtual CHADS2 score ≥ 3 or ≥ 2 PAF-related comorbidities.
Results
Over a median monitoring period of 398 days, PAF was detected in 6/51 (11.8%) patients and anticoagulation was initiated in 5/6 (83.3%). Median time to PAF detection was 87 days (range 0–356 days). Median longest PAF episode was 96 min (range 1 to 1122 min), and 4/6 had multiple PAF recordings. Mean left atrial volume index was significantly higher in PAF patients (31.0 vs. 23.2 cc/m2; p = 0.04).
Conclusion
Long-term monitoring of non-CIS patients detected PAF in a clinically relevant proportion of patients, resulting in stroke prevention therapy optimization. Further study to confirm these findings and refine the subset that would benefit from long-term cardiac monitoring is warranted.
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Acknowledgements
We thank Connie Lau, Ruthanne Carey, and Christina M. Kelly for help in protocol execution and data management.
Funding
Partial funding for this study was provided by Medtronic, Inc.
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The authors declare that they have no conflict of interest.
Ethical standards
The local Institutional Review Board (Northwell IRB) approved the study protocol, all study procedures were performed in accordance with the 1964 Declaration of Helsinki ethical standards, and all participants signed written informed consent prior to study activities.
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Katz, J.M., Eng, M.S., Carrazco, C. et al. Occult paroxysmal atrial fibrillation in non-cryptogenic ischemic stroke. J Neurol 265, 2237–2242 (2018). https://doi.org/10.1007/s00415-018-8982-9
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DOI: https://doi.org/10.1007/s00415-018-8982-9