Large vessel occlusion is independently associated with atrial fibrillation detection

Abstract

Background and purpose Covert paroxysmal atrial fibrillation (pAF) is the most frequent cause of cardiac embolism. Our goal was to discover parameters associated with early pAF detection with intensive cardiac monitoring. Method Crypto‐AF was a multicentre prospective study (four Comprehensive Stroke Centres) to detect pAF in non‐lacunar cryptogenic stroke continuously monitored within the first 28 days. Stroke severity, infarct pattern, large vessel occlusion (LVO) at baseline, electrocardiography analysis, supraventricular extrasystolia in the Holter examination, left atrial volume index and brain natriuretic peptide level were assessed. The percentage of pAF detection and pAF episodes lasting more than 5 h were registered. Results Out of 296 patients, 264 patients completed the monitoring period with 23.1% (61/264) of pAF detection. Patients with pAF were older [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01–1.08], they had more haemorrhagic infarction (OR 4.03, 95% CI 1.44–11.22), they were more likely to have LVO (OR 4.29, 95% CI 2.31–7.97) (P < 0.0001), they had a larger left atrial volume index (OR 1.03, 95% CI 1.01–1.1) (P = 0.0002) and they had a higher level of brain natriuretic peptide (OR 1.01, 95% CI 1.0–1.1). Age and LVO were independently associated with pAF detection (OR 1.06, 95% CI 1.00–1.16, and OR 4.58, 95% CI 2.27– 21.38, respectively). Patients with LVO had higher cumulative incidence of pAF (log rank P < 0.001) and more percentage of pAF > 5 h [29.6% (21/71) vs. 8.3% (12/144); OR 4.62, 95% CI 2.11–10.08; P < 0.001]. In a mean follow‐up of 26.82 months (SD 10.15) the stroke recurrence rate was 4.6% (12/260). Conclusions Large vessel occlusion in cryptogenic stroke emerged as an independent marker of pAF.

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

“…An MVO may therefore be a useful independent predictor of latent AF in CS. Recently, MVO in patients with CS was reported to be independently associated with AF detection through wearable Holter monitoring within a month of stroke onset (9), which was consistent with our results. However, the patients in our cohort underwent ICM implantation 21 (IQR 14-39) days after stroke onset.…”

“…Even among the CS patients with MVO, covert paroxysmal AF might be a major cause of stroke. 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). Recently, long-term recording with insertable cardiac monitoring (ICM) has been shown to be useful for AF detection in CS patients (10).…”

Left Atrial Enlargement on Non-Gated CT Is Associated with Large Vessel Occlusion in Acute Ischaemic Stroke

“…There are emerging prospective data to suggest that in the cryptogenic stroke population, LVO is independently associated with covert paroxysmal AF [16]. There is also a higher incidence of cardioembolic aetiology in LVO re currence [17].…”

B‐type natriuretic peptide over N‐terminal pro‐brain natriuretic peptide to predict incident atrial fibrillation after cryptogenic stroke

“…The Crypto‐AF study was a multicenter observational prospective study to detect subclinical AF in cryptogenic stroke patients [8,9]. Non‐lacunar ischaemic stroke patients (<72 h after stroke) over 55 years of age diagnosed by computed tomography and/or magnetic resonance imaging were included.…”