Yoga vs regular exercise for atrial fibrillation: Design of the yoga-AF randomized controlled trial.

Assessing outcomes in a cardiac sarcoid cohort with implantable loop recorders - a tertiary United Kingdom study.

Abstract Background Elevated pulmonary capillary wedge pressure (PCWP) is known to drive atrial fibrillation (AF). However, it remains unknown if non-invasive Cardiovascular Magnetic Resonance (CMR) - derived PCWP could predict the future risk of AF. This study investigated whether a CMR-derived measure of PCWP could predict future AF. Methods We enrolled 202 participants (mean age 76.2±4.2 years) from the LOOP study, each receiving implantable loop recorder (ILR) for continuous rhythm monitoring over 4 years. CMR imaging quantified left atrial volume (LAV) and left ventricular mass (LVM), allowing calculation of a validated sex-specific equation derived PCWP. Cox proportional hazards analysis identified independent variables associated with incident AF. Results Eighty-six participants (42.6%) manifested AF during follow-up. Individuals with AF exhibited significantly higher CMR-PCWP (16.1±2.8 vs. 14.7±2.3 mmHg, p<0.01) and greater LAV. Univariate regression highlighted that PCWP ≥16 mmHg was significantly associated with incident AF (hazard ratio 2.73). Stepwise Cox regression confirmed that PCWP ≥16 mmHg and the CHARGE-AF score remained independently associated with AF, with PCWP conveying higher hazard ratio (2.88, p<0.001). Kaplan-Meier analysis reinforced the importance of this threshold for AF onset, demonstrating a significantly increased probability of arrhythmia over time and emphasising its decisive clinical impact. Conclusion Elevated CMR-PCWP is associated with AF in older, high-stroke-risk individuals, underscoring the role of subclinical diastolic dysfunction in promoting arrhythmogenesis. Incorporating non-invasive PCWP assessment into routine CMR evaluation may enhance risk stratification, allowing prompt identification of at-risk patients and enabling earlier, precise, targeted measures for AF prevention.

To determine whether exercise training patterns were associated with the incidence and timing of ventricular arrhythmia in veteran male endurance athletes. One-hundred-and-six healthy male endurance athletes (cyclists/triathletes) aged >50y undertaking >10h/week of exercise for >15y underwent clinical assessment, cardiac magnetic resonance (CMR) and implantable loop recorder (ILR) implantation. Daily exercise was tracked with computerised exercise tracking devices. Athletes were followed up for ventricular arrhythmia on ILR; ventricular tachycardia (VT) and non-sustained VT (NSVT). Fifty-five ventricular arrhythmia events occurred (median follow-up 796 days); 3 (5.5%) VT and 52 (94.5%) NSVT in 25 (23.5%) athletes. Myocardial fibrosis was significantly more prevalent in athletes with ventricular arrhythmia than those without ventricular arrhythmia (19 (76.0%) vs 31 (38.3%), P<001).The incidence of exercise-related ventricular arrhythmia was 0.4/1000 hours of exercise versus non-exercise-related ventricular arrhythmia incidence of 0.01/1000 hours of non-exercise. All three sustained VT cases occurred during exercise in athletes with fibrosis and were preceded by NSVT. There were no training differences between athletes with and without ventricular arrhythmia over two years and in the month prior to each arrhythmic event. A significant proportion of highly trained male veteran athletes developed ventricular arrhythmia which was predominantly NSVT and was strongly associated with myocardial fibrosis. Acute exercise exposure was associated with an increased risk of developing ventricular arrhythmia but chronic exercise load was not. Our findings therefore highlight myocardial fibrosis as a potential pro-arrhythmic substrate upon which intense exercise may trigger arrhythmogenesis in certain male veteran athletes.

Implantable loop recorder (ILR) explant has traditionally been performed in catheterization (cath) labs, with bed-based recovery lasting more than 60 min. This conventional model can strain cath lab resources, delay urgent interventional procedures, and inconvenience patients. Currently, there are no standardized guidelines for streamlined ambulatory pathways for ILR removal. To evaluate the feasibility, safety, and efficiency of a nurse-led, chair-based ambulatory pathway for ILR explant. A prospective, single-centre quality improvement project was conducted over a 4-month period. Patients were admitted via reception and transferred to a side room, bypassing the cath lab. Explant procedures were performed by trained nurses with consultant oversight available. Post-procedure, patients recovered in a chair in side room for 10-15 min before discharge. Standard wound care and safety instructions were provided. Safety monitoring, efficiency metrics, and patient satisfaction questionnaires were collected. A 201 patients were enrolled in this study. We compared 101 patients who underwent ILR explant through the ambulatory chair-based pathway to 100 patients who underwent consultant-led cath lab- based traditional pathway. In the new nurse-led chair-based pathway, there were no infections, bleeding, or major complications occurred. One case required consultant intervention due to a deep implant. Patient satisfaction was uniformly high, with no complaints reported. Compared to the traditional model, the new pathway reduced cath lab occupancy and bed utilization. Notably, no cancellations occurred during the study period because of cath lab worklaod, whereas in the cath lab era, cases were often delayed or cancelled due to scheduling conflicts with urgent procedures or using cath lab beds as escalation plan. A nurse-led, chair-based ILR explant pathway is safe, efficient, and highly acceptable to patients. It reduces reliance on cath lab infrastructure, eliminates procedure cancellations, optimizes resource utilization, and has significant implications for reducing waiting list backlogs. This model is reproducible and may inform best practice protocols in other centres.

Subclinical atrial fibrillation (SCAF) poses an increased stroke risk, but whether oral anticoagulation for SCAF prevents stroke is unclear. We sought to investigate the treatment effect of SCAF screening according to measures of cardiac structure and function. This was an echocardiographic substudy of the LOOP (Atrial Fibrillation Detected by Continuous ECG Monitoring) study, which randomized older people at risk of stroke to usual care or an implantable loop recorder (ILR) with monitoring for SCAF and subsequent oral anticoagulation. A subset (24% of trial population) underwent echocardiography to measure left ventricular size and function, left atrial volume and strain, and valvular pathology. The primary outcome was a composite of stroke or systemic embolism. The study included 1422 participants (ILR: n=1001; control: n=421; mean age: 74 years; men: 54%). During follow-up, 354 (25%) were diagnosed with AF (ILR versus control: 30% versus 12%). During a median follow-up of 5.5 years (interquartile range, 4.9-5.9 years), 55 (4%) developed the primary outcome (ILR versus control: 3.9% versus 3.8%). No conventional measure of cardiac structure and function modified the treatment effect from randomization. However, left atrial contraction strain significantly modified the treatment effect (Pinteraction=0.003), such that a lower risk of the primary outcome was noted from ILR with lower left atrial contraction strain values (hazard ratio [HR], 0.38 [95% CI, 0.16-0.87], for participants with contraction strain<16.5%). In a post hoc analysis of the LOOP study, conventional echocardiographic measures did not modify the effect of SCAF screening for stroke prevention. However, a significant stroke risk reduction was observed from ILR randomization among participants with reduced left atrial contraction strain.

ABSTRACTBackgroundCryptogenic strokes (CS) represent one third of admissions for stroke. Silent paroxysmal atrial fibrillation (PAF) is the underlying cause of a significant proportion of cases. The use of internal loop recorders (ILR) after CS has shown controversial results, remaining unclear in guidelines. Subtle ultrasound left atrium (LA) anomalies may help select patients more prone to suffer from silent PAF who can benefit from an ILR.MethodsRandomized, controlled, parallel‐arm, open‐label trial of patients with CS. We evaluated the efficacy of early ILR for detection of silent PAF episodes compared to standard care. Clinical/ultrasound predictors of PAF were studied. The presence of subtle LA anomalies (any of: LA dilatation, maximum systolic global longitudinal strain < 21%, atrial contraction strain < 13%, atrial ejection fraction < 55%) was used in a pre‐specified subgroup analysis.ResultsFifty‐nine CS patients were included (52.5% to ILR and 47.5% to standard care). There were no statistically significant differences among groups regarding baseline characteristics. Median follow‐up was 377 days. The diagnosis of silent PAF was made in 43.3% in the ILR group compared to 7.1% in the control group (HR 7.47, 95% CI 1.68–31.19, p = 0.008). Most PAF events were detected in the 100 days following ILR implantation. In patients with normal LA, PAF was observed in 23% versus 7%, while in patients with abnormal LA, PAF was diagnosed in 58.8% versus 7.7%.ConclusionsAn ILR implanted early after CS improves the detection of PAF compared to standard care. Individuals with abnormal LA features may benefit the most from ILR.

Prevalence of clinically significant bradyarrhythmias in patients implanted with loop recorders for cryptogenic stroke: A manifestation of atrial cardiomyopathy?

To summarise contemporary strategies to detect atrial fibrillation (AF) after stroke/transient ischemic attack (TIA) with emphasis on implantable loop recorders (ILRs), evaluate who should receive anticoagulation in device detected AF/atrial high-rate episodes, and evaluate biomarkers that increase the likelihood of detecting AF. ILRs substantially increase AF detection beyond 12-36 months of monitoring. General population screening with ILRs increases AF diagnosis without a definitive stroke reduction. For subclinical/device detected AF, anticoagulation may reduce stroke but comes at the expense of increased bleeding. The burden of AF, biomarkers and atrial cardiomyopathy markers show promise to stratify risk and guide extended monitoring. An individualized approach is needed to identify who benefits most from ILR and subsequent anticoagulation. Research priorities include outcome-powered trials after stroke/TIA, the role of AF burden in decision making and the role of wearables within clinical pathways.

Post-stroke atrial fibrillation (AFib) is a frequent yet undetected complication, particularly in resource-limited settings, where systematic screening remains challenging. Timely identification is essential for guiding anticoagulation strategies and reducing recurrent stroke risk. This scoping review synthesizes evidence on predictive strategies integrating artificial intelligence, circulating biomarkers, and advanced rhythm-monitoring modalities in adults with ischemic stroke or transient ischemic attack without known AFib. Predictive variables from conventional clinical scores and modern AI-based models were harmonized into a unified framework, highlighting incremental contributions from natriuretic peptides, imaging radiomics, and electronic health record-derived laboratory parameters. A novel analytical construct-area under the curve (AUC)-cost-feasibility mapping-was introduced to compare diagnostic strategies, including risk scores, handheld and patch electrocardiography, smartwatch-based photoplethysmography (with ECG confirmation required for diagnosis), and implantable loop recorders, with explicit consideration of scalability in low- and middle-income countries. Based on this synthesis, a tiered diagnostic pathway is proposed, combining clinical risk stratification with biomarker-guided triage (particularly NT-proBNP and MR-proANP) to inform allocation of extended monitoring resources, thereby optimizing diagnostic yield and cost-effectiveness. Persistent knowledge gaps include the absence of standardized biomarker thresholds, limited head-to-head evaluations of AI-enabled workflow in post-stroke populations, insufficient external validation in diverse populations, and a lack of prospective cost-effectiveness analyses. By integrating predictive domains, quantifying performance-cost trade-offs, and outlining an implementation-oriented, risk-stratified strategy, this review aims to inform AFib screening after stroke from theoretical innovation toward context-adapted clinical application, offering a structured framework to guide both research and practice in diverse healthcare environments.

Embolic stroke of undetermined source (ESUS) is frequently attributable to atrial fibrillation (AF), yet remains undetected when episodes are brief or asymptomatic. Digital health-enabled cardiac monitoring offers novel pathways for secondary prevention. Implantable loop recorders (ILRs) provide continuous long-term rhythm surveillance, while wearable electrocardiogram (ECG) devices offer greater accessibility but with uncertain diagnostic yield and economic value. We evaluated the cost-effectiveness of ILR versus wearable AF monitoring and usual care in ESUS. A cohort-based Markov model simulated 1,000 ESUS patients (mean age 65 years) over a 10-year horizon from the German statutory health insurance perspective. Clinical inputs included AF detection rates (ILR: 15-25%; wearables: 5-10%), risk reduction in ischemic stroke with oral anticoagulation (OAC), and mortality/disability utilities. Costs (EUR 2,024, 3% discount) captured device acquisition, implantation, follow-up, stroke care, and OAC therapy. Outcomes included incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit at willingness-to-pay thresholds of EUR 20,000, EUR 30,000, and EUR 50,000/quality-adjusted life-year (QALY). Deterministic and probabilistic sensitivity analyses, including expected value of perfect information (EVPI), were performed. ILR yielded 0.23 additional QALYs compared with wearables at an incremental cost of EUR 2,160, resulting in a base-case ICER of EUR 9,391/QALY. In a high-risk subgroup, the ICER decreased to EUR 5,520/QALY. Probabilistic analysis demonstrated >90% probability of cost-effectiveness at EUR 30,000/QALY, with moderate EVPI. These findings align with meta-analytic evidence (RR 3.88 for AF detection; RR 0.75 for stroke reduction) and indicate that prolonged monitoring (≥12 months) maximizes yield. Digital health-enabled ILR monitoring is likely cost-effective for AF detection after ESUS, particularly in high-risk patients. Wearables may serve as an adjunct but deliver lower value. Results support targeted ILR implementation in post-ESUS care pathways and integration into digital health-driven guideline and reimbursement frameworks.

The subclinical atrial &amp;#64257; brillation (SCAF) in patients with cardiac implanted electronic devices (CIED) is a critical area of research in cardiology. It represents episodes of atrial &amp;#64257; brillation (AF) that occur in patients without any noticeable symptoms, registered by electronic devices for prolonged rhythm monitoring. Because of that, early diagnosis has proven to be dif&amp;#64257; cult in the absence of advanced monitoring tools, such as smart electronic devices or implantable cardiac hardware. CIED, such as permanent pacemakers (PPM), implantable cardioverter de&amp;#64257; brillators (ICD), resynchronization devices (CRT) and Loop Recorders (IRL) are fundamental in the detection of such episodes and provide continuous monitoring of the cardiac electrical activity. The early detections of SCAF provide the ability to initiate early prophylactic or therapeutic measurements that will help reduce not only the burden of disease, but also to reduce morbidity and mortality. The widespread use of CIED`s and wearable devices has led to the detection of subclinical AF in a signi&amp;#64257; cant portion of the population. Thus, this detection may often help reduce the incidents of thromboembolism by initiating anticoagulation therapy. However, it is still unknown at what point and in which population long-term anticoagulation is bene&amp;#64257; cial, having also in consideration the hemorrhagic risk. This review aims to explore the existing data and to identify the current gaps in knowledge.

The role of echocardiography is critical in the diagnostic evaluation and management of ischemic stroke, especially cryptogenic stroke, in which the cause is unknown. About 15-30% of ischemic strokes are caused by cardiogenic embolism, making cardiac imaging a critical component of evaluation. Guidelines from the American Heart Association and the American College of Cardiology highlight the importance of echocardiography and mobile cardiac telemetry or implantable loop recorders to identify possible sources of cardiac embolism and monitor for atrial fibrillation, thus guiding secondary prevention.Transthoracic echocardiography (TTE) is widely used as an initial tool to assess cardiac structure and function, detect intracardiac thrombi, and evaluate valvular abnormalities. Transesophageal echocardiography (TEE), as well as cardiac CT and MRI, offer enhanced visualization of certain cardiac structures, identifying embolic sources not readily visible on TTE, such as left atrial appendage thrombi and patent foramen ovale (PFO).The comprehensive diagnostic approach for cryptogenic stroke (CS) includes brain imaging (CT or MRI), neurovascular imaging, electrocardiography (ECG), and vascular ultrasound.Echocardiography plays a crucial role in assessing left atrial and ventricular thrombi, valvular disease, and aortic plaques. Additionally, advancements in echocardiography, such as real-time three-dimensional imaging, are emphasized for their potential to enhance stroke prevention and management strategies.

External validation of atrial fibrillation risk scores in heart failure under continuous device surveillance.

The coronavirus disease 2019 (COVID-19) pandemic has revealed a close and multifaceted relationship between viral infection, systemic inflammation, and cardiovascular health. Among the cardiac complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), atrial fibrillation (AF)-especially new-onset atrial fibrillation (NOAF)-has emerged as a major determinant of disease severity and prognosis. Clinical studies and meta-analyses show that 5-10% of hospitalized COVID-19 patients develop AF, with markedly higher rates in critically ill individuals. Both pre-existing and NOAF are independently associated with increased risks of intensive care admission, mechanical ventilation, thromboembolic events, and mortality. The underlying mechanisms involve a combination of cytokine-mediated inflammation, endothelial dysfunction, microvascular injury, and dysregulation of the renin-angiotensin-aldosterone system (RAAS). Viral downregulation of angiotensin-converting enzyme 2 (ACE2) receptors contributes to myocardial fibrosis, while hypoxia, oxidative stress, and autonomic imbalance further promote electrical remodeling and arrhythmogenesis. Post-infectious studies indicate that atrial structural changes and autonomic dysfunction may persist for months, predisposing survivors to recurrent arrhythmias. Technological advances in telecardiology and digital medicine have provided new tools for early detection and long-term monitoring. Wearable electroencephalography (ECG) devices, implantable loop recorders (ILRs), and artificial intelligence (AI)-based diagnostic algorithms enable continuous rhythm surveillance and individualized management, improving outcomes in post-COVID patients. This review summarizes current evidence on the epidemiology, pathophysiology, clinical implications, and monitoring strategies of AF in COVID-19. It underscores the importance of integrating telemedicine and AI-assisted diagnostics into cardiovascular care to mitigate the long-term arrhythmic and systemic consequences of SARS-CoV-2 infection.

Background/Objectives: Arrhythmic recurrence is a common issue affecting a significant percentage of patients undergoing transcatheter ablation (TCA) of Atrial Fibrillation (AF). The use of artificial intelligence (AI) for the identification of electrocardiographic predictors of post-ablation recurrence may offer a valuable and cost-effective approach to improve risk stratification and optimize follow-up. This study aims to investigate the relationship between post-procedural electrocardiographic (ECG) P-wave parameters, measured using AI, and AF recurrence in patients undergoing transcatheter ablation (TCA). Methods: Seventy-four patients (age 62.36 ± 10.4 years) with a diagnosis of AF were retrospectively analyzed. ECGs were processed using AI software to analyze P-wave-related variables. All patients had either an implantable loop recorder (ILR) or another form of cardiac implantable electronic device (CIED). Results: Post-procedural P-wave amplitude in lead II (PwA in lead II) showed a significant association with AF recurrence, defined as an average arrhythmic burden >6% at one-year follow-up. Conclusions: These findings underscore the potential of PwA in lead II as a biomarker for the follow-up of patients undergoing TCA and highlight the contribution of AI in the analysis of electrocardiographic parameters predictive of AF recurrence. Together, these results may contribute to the development of early risk-stratification strategies following catheter ablation.

The frequency and clinical significance of non-sustained ventricular tachycardia (NSVT) detected on ambulatory monitors in pediatric and congenital heart disease (CHD) patients (pts) has not been thoroughly investigated. This study aims to examine the prevalence of NSVT, analyze the presence of associated cardiovascular disease, and describe changes in management. We performed a retrospective cohort study of all pts evaluated in cardiology clinic at Cleveland Clinic who were found to have NSVT on ambulatory patch monitors (2017-2023). Among 2805 pts, 172 (age 29 ± 14, range: 3-81) had NSVT yielding a prevalence of 6% and a monitoring duration of 7.5 ± 5.5 days. Cardiac diagnoses included: 57% CHD, 26% structurally normal hearts, 8% cardiomyopathy, 6% connective tissue disorder, and 3% channelopathy. Mean day of NSVT detection was 4.3 ± 3.7 days without significant difference amongst the various underlying cardiac diagnoses. Management changes were made in 52 pts: medication change in 43, loop recorder placement in 4, and cardiac defibrillator placement in 5. Five pts died with 1 suspected sudden cardiac death. The likelihood of NSVT detection increased with longer monitoring duration with only 55% of cases detected at 2 days. In a multivariable model, monitoring duration but not underlying diagnosis, age, monitor indication, or single ventricle status, was associated with the likelihood of NSVT detection. While NSVT is relatively uncommon, it is increasingly detected in pediatric and CHD pts with longer monitoring durations, regardless of the underlying cardiac condition. Although medical management changes based on monitor findings were frequent, sudden death was rare.

Cardiac arrhythmias remain one of the leading causes of cardiovascular morbidity and mortality worldwide. Over the past decade, diagnostic and therapeutic approaches have undergone a profound transformation driven by technological innovation, artificial intelligence (AI), and evidence-based medicine. This review analyzes the main advances in arrhythmia diagnosis and management, emphasizing the global perspective and its implementation in Latin America, particularly in Mexico, Colombia, and Ecuador. A narrative review was conducted using the Scientific Method and the DMAIC framework, analyzing twenty peer-reviewed publications, clinical trials, and international guidelines published between 2014 and 2024. The evidence reveals a transition from conventional electrocardiographic methods such as 24-hour Holter monitoring to extended adhesive patch ECGs, implantable loop recorders, and wearable devices supported by AI algorithms, which have significantly improved diagnostic precision and early detection of subclinical arrhythmias. Therapeutically, clinical trials such as EAST-AFNET 4, CABANA, EARLY-AF, and STOP AF First demonstrated that early rhythm-control strategies, particularly catheter and cryoballoon ablation, provide better rhythm maintenance, reduce cardiovascular events, and modify the natural course of atrial fibrillation. Furthermore, the integration of telecardiology, device remote monitoring, and cardiogenetic evaluation is progressively redefining contemporary arrhythmia care. Despite persistent disparities in access and infrastructure, Latin American countries are adopting hybrid diagnostic and therapeutic models aligned with international standards. In conclusion, modern arrhythmia management has evolved into a proactive, technology-driven, and patient-centered discipline, where early rhythm control, AI-assisted monitoring, and regional collaboration are essential to improve outcomes and achieve equitable cardiovascular care worldwide.

BACKGROUND Implantable loop recorders (ILRs) are important tools in diagnosing unexplained syncope and palpitations through prolonged rhythm monitoring. However, ILRs can produce false-positive arrhythmia detections, due to signal oversensing and undersensing, which can complicate clinical interpretation. Oversensing typically involves P waves, T waves, or myopotentials; however, simultaneous oversensing and undersensing of multiple waveform components is rare. We report a case of R-wave oversensing of P waves and T waves, with undersensing of QRS complexes, resulting in erroneous atrial fibrillation (AF) alerts. CASE REPORT A 73-year-old woman with hypertension and hyperlipidemia presented with recurrent lightheadedness, palpitations, and hypotension. After an unrevealing initial workup, a Biotronik Biomonitor III ILR was implanted. Within 3 months, the device flagged over 200 episodes of AF and several ventricular fibrillation episodes, despite the patient remaining asymptomatic. Careful signal review revealed a triple-sensing issue of cardiac signals, leading to misclassification of arrhythmias. The sensing filter was reprogrammed from 10 Hz to 24 Hz, resulting in elimination of false-positive detections. Following reprogramming, the patient remained asymptomatic with no further inappropriate arrhythmia alerts and did not require additional interventions. CONCLUSIONS This case highlights a rare example of R-wave oversensing and undersensing by an ILR, emphasizing the importance of individualized device programming to optimize diagnostic accuracy. Additionally, it illustrates that unconventional implantation sites, such as the right parasternal region, can produce unique sensing challenges. Careful review of device signals and appropriate reprogramming can correct oversensing issues, preventing unnecessary interventions and improving patient management.

Atrial fibrillation (AF) detected after stroke or transient ischemic attack (AFDAS) is a critical but often underdiagnosed condition with implications for secondary stroke prevention. This distinctive type of AF is increasingly studied to provide a more comprehensive understanding of its complex pathophysiology, which may involve both cardiogenic mechanisms and stroke-induced autonomic dysfunction, a concept known as the neurogenic hypothesis. This study aims to identify the prevalence and predictors of AFDAS to help refine monitoring strategies and improve patient outcomes. We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We included English-language retrospective and prospective cohort studies published from January 1999 to January 2025, analyzing data from 91 studies for prevalence and 54 studies for predictors. We categorized AF detection by different monitoring methods, including electrocardiogram (ECG), Holter monitoring, external loop recorders, and implantable cardiac monitors (ICM). Predictors were grouped into demographic, cardiogenic, neurogenic, and laboratory factors. The overall prevalence of AFDAS varied significantly based on monitoring technique. The pooled prevalence was 7% (95% CI 4.6-10.5) by emergency room ECG, 12.7% (95% CI 9-17.8) by inpatient ECG, 11.9% (95% CI 7.8-17.9) by continuous ECG monitoring, 11.5% (95% CI 8-16.1) by external loop recording, 5.1% (95% CI 2.6-9.7) by Holter monitor, 21.3% (95% CI 18.3-24.7) by ICM, and 17.2% (95% CI 10-28.1) by multiple monitoring methods. Key predictors of AFDAS included older age, female sex, hypertension, chronic kidney disease, left atrial enlargement, advanced interatrial block, and higher NIHSS scores. Insular involvement and major strokes were strongly associated with AF detection, supporting the neurogenic hypothesis. Elevated N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) and B-type Natriuretic Peptide (BNP) levels were also linked to a higher AF risk. AFDAS is a frequent but variably detected condition, with its prevalence strongly dependent on monitoring duration and modality. Identifying high-risk patients using a combination of clinical, cardiogenic, neurogenic, and laboratory markers can optimize screening strategies and early anticoagulation initiation, potentially reducing stroke recurrence. Future research should focus on refining risk scores integrating neurogenic and cardiogenic markers to guide personalized monitoring approaches and to define the distinct characteristics of AFDAS from known atrial fibrillation (KAF).