Paroxysmal atrial fibrillation is often suspected as a probable cause of cryptogenic stroke. Continuous longterm ECG monitoring using insertable cardiac monitors is a clinically effective technique to screen for atrial fibrillation and superior to conventional follow-up in cryptogenic stroke. However, more studies are needed to identify factors

Introduction: Secondary stroke prevention depends on proper identification of the underlying etiology and initiation of optimal treatment after the index event. The aim of the NOR-FIB study was to detect and quantify underlying atrial fibrillation (AF) in patients with cryptogenic stroke (CS) or transient ischaemic attack (TIA) using insertable cardiac monitor (ICM), to optimise secondary prevention, and to test the feasibility of ICM usage for stroke physicians. Patients and methods: Prospective observational international multicenter real-life study of CS and TIA patients monitored for 12 months with ICM (Reveal LINQ) for AF detection. Results: ICM insertion was performed in 91.5% by stroke physicians, within median 9 days after index event. Paroxysmal AF was diagnosed in 74 out of 259 patients (28.6%), detected early after ICM insertion (mean 48 ± 52 days) in 86.5% of patients. AF patients were older (72.6 vs 62.2; p < 0.001), had higher pre-stroke CHA₂DS₂-VASc score (median 3 vs 2; p < 0.001) and admission NIHSS (median 2 vs 1; p = 0.001); and more often hypertension ( p = 0.045) and dyslipidaemia ( p = 0.005) than non-AF patients. The arrhythmia was recurrent in 91.9% and asymptomatic in 93.2%. At 12-month follow-up anticoagulants usage was 97.3%. Discussion and conclusions: ICM was an effective tool for diagnosing underlying AF, capturing AF in 29% of the CS and TIA patients. AF was asymptomatic in most cases and would mainly have gone undiagnosed without ICM. The insertion and use of ICM was feasible for stroke physicians in stroke units.

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Nevrologisk avdelingOslo universitetssykehus Forfa erbidrag: idé, utforming/design, li eratursøk, utarbeiding/revisjon av manuset samt godkjenning av innsendte manusversjon. Brian Anthony Enriquez er spesialist i nevrologi og overlege. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Nevroradiologisk enhetOslo universitetssykehus, Rikshospitalet Forfa erbidrag: revisjon av manuset og godkjenning av innsendte manusversjon. Bjørn Tennøe er spesialist i radiologi og overlege i team for nevrovaskulaer intervensjon. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Nevroradiologisk enhetOslo universitetssykehus, Rikshospitalet Forfa erbidrag: revisjon av manuset og godkjenning av innsendte manusversjon. Terje Nome er spesialist i radiologi og overlege i team for nevrovaskulaer intervensjon. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Nevroradiologisk enhetOslo universitetssykehus, Rikshospitalet Forfa erbidrag: revisjon av manuset og godkjenning av innsendte manusversjon. Øyvind Gjertsen er spesialist i radiologi og overlege i team for nevrovaskulaer intervensjon. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Nevroradiologisk enhetOslo universitetssykehus, Rikshospitalet Forfa erbidrag: godkjenning av innsendte manusversjon. Bård Nedregaard er spesialist i radiologi og overlege i team for nevrovaskulaer intervensjon. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter.Mekanisk trombektomi ved aku hjerneinfarkt | Tidsskrift for Den norske legeforening

Background and purpose There are currently no biomarkers to select cryptogenic stroke (CS) patients for monitoring with insertable cardiac monitors (ICMs), the most effective tool for diagnosing atrial fibrillation (AF) in CS. The purpose of this study was to assess clinically available biomarkers as predictors of AF. Methods Eligible CS and cryptogenic transient ischaemic attack patients underwent 12‐month monitoring with ICMs, clinical follow‐up and biomarker sampling. Levels of cardiac and thromboembolic biomarkers, taken within 14 days from symptom onset, were compared between patients diagnosed with AF (n = 74) during monitoring and those without AF (n = 185). Receiver operating characteristic curves were created. Biomarkers reaching area under the receiver operating characteristic curve ≥ 0.7 were dichotomized by finding optimal cut‐off values and were used in logistic regression establishing their predictive value for increased risk of AF in unadjusted and adjusted models. Results B‐type natriuretic peptide (BNP), N‐terminal pro‐brain natriuretic peptide (NT‐proBNP), creatine kinase, D‐dimer and high‐sensitivity cardiac troponin I and T were significantly higher in the AF than non‐AF group. BNP and NT‐proBNP reached the predefined area under the curve level, 0.755 and 0.725 respectively. Optimal cut‐off values were 33.5 ng/l for BNP and 87 ng/l for NT‐proBNP. Regression analysis showed that NT‐proBNP was a predictor of AF in both unadjusted (odds ratio 7.72, 95% confidence interval 3.16–18.87) and age‐ and sex‐adjusted models (odds ratio 4.82, 95% confidence interval 1.79–12.96). Conclusion Several clinically established biomarkers were associated with AF. NT‐proBNP performed best as AF predictor and could be used for selecting patients for long‐term monitoring with ICMs.