Abstract 13949: Age-Dependent Detection of Atrial Fibrillation With Implantable Cardiac Monitors in Patients With Cryptogenic Stroke

Abstract

Introduction: Prolonged and intensified rhythm monitoring is recommended to detect atrial fibrillation (AF) in patients with cryptogenic stroke (CS). Continuous monitoring using implantable cardiac monitors (ICM) results in AF detection rates of up to 30%. Although higher age has been identified as an independent risk factor for AF after CS, there are no specific recommendations for the implantation of ICM in younger patients. Hypothesis: AF dectection in young patients (< 60 years) with CS and continuous rhythm monitoring is low. Methods: From 02/2014 to 11/2021, 186 patients (mean age 65 ± 12 years) with cryptogenic stroke were included in this analysis. All patients underwent 72-h ECG monitoring, transcranial Doppler Ultrasound and transthoracic echocardiography according to current guidelines. Follow-up was performed by means of a regular outpatient presentation every three months and included medical history, physical examination, and interrogation of the ICM. AF was defined as any episode of absolute arrhythmia >30 seconds. Results: AF was detected in 62 patients (33 %) during a mean follow-up of 36 ± 23 months. AF was found in 6 % (3/52), 27 % (17/62), 56 % (31/55) and 65 % (11/17) (p < 0.001) in patients aged < 60 years, 60-69 years, 70-79 years and ≥ 80 years, respectively (see Figure 1). All patients with AF under 60 years had an impaired systolic left ventricular function (left ventricular ejection fraction < 50 %). Conclusions: In cryptogenic stroke patients, detection of Atrial Fibrillation by implantable cardiac monitors increases with advanced age. In patients younger than 60 years, Atrial Fibrillation was only detected in patients with impaired systolic left ventricular function. The diagnostic benefit of ICM implantation in young patients with cryptogenic stroke and preserved LV function is limited. Possibly positive predictors for AF detection should be identified and considered in the decision to implant cardiac monitors.