Abstract TP276: AF Detection on Zio-Patch is Higher in ESUS vs. Non-Cardioembolic Stroke Subtype

Abstract

Background: Clinical trials showed that the paroxysmal occult AF is detected in 30% of patients with cryptogenic stroke on insertable cardiac monitors but recently the STROKE-AF trial showed a similar rate in patients with non-cardioembolic stroke, thus questioning the significance of device detected AF as a cause of the ischemic stroke. In this study, we aim to compare AF detection rates in patients with ESUS compared to those with non-cardieombolic stroke mechanisms on ZIOPATCH monitoring. Methods: We analyzed data of patients with acute ischemic stroke who had a two-week ZIOPATCH monitor placed post stroke over a 2 year period. We collected data on demographics, risk factors, and ZIOPATCH findings in all patients. Stroke subtype was categorized based on the TOAST criteria into small vessel disease, large artery atherosclerosis, stroke of other determined mechanism, and cryptogenic stroke. Cryptogenic stroke was defined based on the ESUS criteria. AF was abstracted from the ZIOPATCH report and confirmed by the reviewing physician. We determined association between stroke subtype (ESUS versus non-cardioembolic stroke) and AF detection using multivariable models. Results: Over the study period, we identified 239 patients discharged with a diagnosis of acute ischemic stroke who underwent cardiac monitoring via a 2-week ZIOPATCH with a median of 13 days of monitoring; 116 (49%) were ESUS and 65 (27%) were classified as large artery atherosclerosis and 19% were classified as small vessel disease. AF was detected 3.3% (8/239) of patients. In univariate analyses, patients with ESUS were more likely to have AF compared to non-cardieombolic stroke (6.0% vs. 0.8%, p = 0.032). In an adjusted model controlling for age, patients with ESUS were more likely to have AF detected on ZIOPATCH (aOR 7.53, p = 0.06). Conclusions: Paroxysmal occult AF detected on a 2-week ZIOPATCH is more likely to occur in ESUS vs. non-cardioembolic suggesting a mechanistic association with cardioembolism.