Different aspects of early and late development of atrial fibrillation during hospitalization in cryptogenic stroke

Ryosuke Doijiri,Muneaki Kikuno,Ayako Kuriki,Takahiko Kikuchi,Kodai Kanemaru,Nobutaka Hattori,Yuji Ueno,Takao Urabe,Takahiro Shimizu,Eriko Yamaguchi,Yoshiaki Shimada,Masafumi Ihara,Yuki Kamiya,Hidehiro Takekawa,Yasuhiro Hasegawa,Koichi Hirata,Akira Tsujino,Yohei Tateishi,Masatoshi Koga

doi:10.1038/s41598-021-86620-5

Abstract

The detection of underlying atrial fibrillation (AF) has become increasingly possible by insertable cardiac monitoring (ICM). During hospitalization for cryptogenic stroke, factors related to the early and late development of AF have not been studied. CHALLENGE ESUS/CS is a multicenter registry of cryptogenic stroke patients undergoing transesophageal echocardiography. Twelve-lead electrocardiogram, continuous cardiac monitoring, and 24-h Holter electrocardiogram were all used for the detection of AF. Early and late detection of AF was determined with an allocation ratio of 1:1 among patients with AF. A total of 677 patients (68.7 ± 12.8 years; 455 men) were enrolled, and 64 patients developed AF during hospitalization. Four days after admission was identified as the approximate median day to classify early and late phases to detect AF: ≤ 4 days, 37 patients; > 4 days, 27 patients. Multiple logistic regression analysis showed that spontaneous echo contrast (SEC) (OR 5.91; 95% CI 2.19–15.97; p < 0.001) was associated with AF ≤ 4 days, whereas a large infarction > 3 cm in diameter (OR 3.28; 95% CI 1.35–7.97; p = 0.009) was associated with AF > 4 days. SEC and large infarctions were important predictors of in-hospital AF detection, particularly in the early and late stages, respectively; thus, they could serve as indications for recommending ICM.

Highlights

The detection of underlying atrial fibrillation (AF) has become increasingly possible by insertable cardiac monitoring (ICM)
Using data from CHALLENGE embolic stroke of undetermined source (ESUS)/CS registry with comprehensive data including detection of AF, we explored the clinical characteristics of patients with early and late development of AF in the hospital after cryptogenic stroke
The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 2, and AF was detected in 64 patients (9.5%)

Summary

Introduction

The detection of underlying atrial fibrillation (AF) has become increasingly possible by insertable cardiac monitoring (ICM). Clinical characteristics are yet to be elucidated Despite these interests, there is no available evidence regarding the impact of early- and late-phase AF detection, and for clarifying the clinical manifestations of patients with late-phase AF detection to enable stratifying patients for whom prolonged cardiac monitoring, such as ICM, is indicated in cryptogenic stroke. Transesophageal echocardiography (TEE) is critical to assess cardiac parameters related to AF, screen for diverse potential embolic sources in cryptogenic stroke and ESUS, and guide optimal therapeutic m anagement[3,13]. Using data from CHALLENGE ESUS/CS registry with comprehensive data including detection of AF, we explored the clinical characteristics of patients with early and late development of AF in the hospital after cryptogenic stroke

Methods

Results

Discussion

Conclusion