Paroxysmal Atrial Fibrillation in Cryptogenic Stroke Patients With Major-Vessel Occlusion.

Ryosuke Doijiri,Masafumi Morimoto,Hiroshi Yamagami,Hidekazu Yamazaki,Kazutaka Sonoda,Tomonori Iwata,Tetsuya Hashimoto,Kenichi Todo,Junpei Koge,Naoto Kimura

doi:10.3389/fneur.2020.580572

Abstract

Background and Purpose: To determine whether acute major-vessel occlusion (MVO) predicts atrial fibrillation (AF) in cryptogenic stroke (CS) patients, we analyzed the association between acute MVO and AF detected by insertable cardiac monitoring (ICM).Methods: We conducted a retrospective, multicenter, observational study of patients with CS who underwent ICM implantation between October 2016 and March 2018. In this analysis, we included follow-up data until June 2018. We analyzed the association of MVO with AF detected by ICM.Results: We included 84 consecutive patients with CS who underwent ICM implantation. The proportion of patients with newly detected AF by ICM was higher in patients with MVO than in those without (41% [12/29] vs. 13% [7/55], p < 0.01) within 90 days of ICM implantation. The MVO was associated with AF after adjustment for each clinically relevant factor.Conclusions: MVO was independently associated with AF detection in patients with CS, which suggests that MVO may be a useful predictor of latent AF. It is therefore essential to actively assess latent AF in patients with CS presenting with MVO.

Highlights

Patients with atrial fibrillation (AF) have a 4.8-fold higher risk of developing a stroke compared to those without [1] and is associated with increased stroke severity [2, 3]
After completing diagnostic tests, the local physicians classified a patient as having a cryptogenic embolism when catheter, computed tomography, or magnetic resonance angiography showed an abrupt vessel cutoff in an otherwise normal-appearing artery, which is a culprit of infarction, when imaging evidence showed complete recanalization of the previously occluded artery, or when multiple acute infarctions were present without abnormality in the relevant vessels
We could not acquire the data of premature atrial contraction (PAC) with 24-h Holter electrocardiogram for 17 patients, natriuretic peptide for three patients, or left atrial diameter (LAD) for three patients

Summary

Introduction

Patients with atrial fibrillation (AF) have a 4.8-fold higher risk of developing a stroke compared to those without [1] and is associated with increased stroke severity [2, 3]. Major Vessel Occlusion in Cryptogenic Stroke cause of stroke remains undetermined and is diagnosed as cryptogenic stroke (CS) in 9 to 25% of ischemic stroke patients [6]. Using a wearable 28-day Holter monitor starting 24– 72 h after stroke, large-vessel occlusion in patients with CS was reported to be independently associated with atrial fibrillation detection [9]. To determine whether acute major-vessel occlusion (MVO) predicts atrial fibrillation (AF) in cryptogenic stroke (CS) patients, we analyzed the association between acute MVO and AF detected by insertable cardiac monitoring (ICM)

Methods

Results

Conclusion