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

Maria Vittoria De Angelis,Marco Onofrj,Raffaella Franciotti,Nanda Furia,Vincenzo Di Stefano,Massimiliano Faustino,Enrico Di Girolamo

doi:10.1038/s41598-020-60180-6

Maria Vittoria De Angelis, Marco Onofrj + Show 5 more

Open Access

https://doi.org/10.1038/s41598-020-60180-6

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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.

Highlights

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 included all patients admitted to the Neurological Clinic of “SS Annunziata” hospital of Chieti, which received an insertable cardiac monitor (ICM) after a cryptogenic stroke
Patients were divided into two groups based on the presence (AF group) or absence of AF

Summary

Introduction

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. The risk of stroke in patients with AF can be estimated by the CHA2DS2-VASc score[17], but, even in the presence of strong suspicion, AF may not be detected in the acute phase of ischemic stroke, due to its paroxysmal and asymptomatic nature[18,19,20,21] For this reason, many strategies have been explored to improve detection of AF, ranging from in-hospital monitoring, serial electrocardiography and Holter monitoring and the use of external events (or loop recorders) or insertable cardiac monitors (ICM)[22,23,24]. More recent studies www.nature.com/scientificreports explored the incidence of AF in real-world cohorts of patients with an ICM implanted after a CS (cardiac event monitor) with a relatively brief follow-up[26,31]. The wide use of ICMs in clinical practice could significantly enhance the detection of AF and improve the prognosis, allowing early initiation of anticoagulant therapy, in a relevant percentage of patients with CS

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