Stroke patients with atrial fibrillation detected by implantable loop recorder - Clinical profile, treatment and follow-up

Abstract

The majority of non-lacunar cryptogenic stroke are embolic and had been reclassified as embolic strokes of undetermined source (ESUS). We aimed to characterize the clinical profile and follow-up of patients (pts) with ESUS and atrial fibrillation (AF) detected with implantable loop recorder (ILR) from our stroke database. From June 2014 to December 2018, 17 consecutive pts admitted with ESUS received ILR. These pts had all previous cardiac work-up negative for embolic source (continuous telemetry, ECG, 24 hours Holter, transthoracic and transoesophageal echocardiography) and no prothrombotic conditions. We analysed the pts with AF detection by ILR. AF detection occurred in 5 pts (29.4%; mean age79.6±3.4; 60% male) with ILR. All pts had hypertension and 2 pts dyslipidemia. The stroke localization was medium cerebral artery in all pts. Two pts had left atrial enlargement. The mean time from ILR placement to AF diagnostic was 165.5 days [range 29 - 268]. Mean follow-up was 736.7 days. The treatment was anticoagulation in all 5 pts. There was one recurrence. NIHSS in admission 5±1.6; last evaluation 3.2±0.82 (p=0.051). Old age, hypertension and dyslipidemia were the most conditions associated with AF detection in patients with ESUS. Left atrial enlargement occurred in less pts than we expected. The functional outcome was good. This small study analysed the patients who benefit more ILR for AF detection, but further investigational trials should be done.