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

Yamagami, Hiroshi; Morimoto, Masafumi; Iwata, Tomonori; Hashimoto, Tsuyoshi; Sonoda, Kazutaka; Hidekazu, Yamazaki; Koge, Junpei; Kimura, Naoto; Todo, Kenichi

doi:10.3389/fneur.2020.580572

Cited by 14 publications

(18 citation statements)

References 28 publications

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“…Importantly, AF was diagnosed in 64.3% of patients with whole-territorial infarction patterns in initial neuroimaging. The presence of major-vessel occlusion is also a useful predictor of occult AF in the previous report ( 14 , 15 ). We analyzed more expanded concepts, such as the patients with major territorial infarctions without significant major vessel occlusion or apparently transient ischemic symptoms such as global aphasia with right-side weakness.…”

Section: Discussionmentioning

confidence: 67%

Impact of Neuroimaging Patterns for the Detection of Atrial Fibrillation by Implantable Loop Recorders in Patients With Embolic Stroke of Undetermined Source

Kim

Boo²,

Kang³

et al. 2022

Front. Neurol.

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ObjectivesA trial fibrillation (AF) is a well-known etiology of embolic stroke of undetermined source (ESUS), although the optimal detection strategy of AF was not been fully evaluated yet. We assessed AF detection rate by implantable loop recorder (ILR) in patients with ESUS and compared the clinical characteristics and neuroimaging patterns between the patients with AF and AF-free patients.MethodsWe reviewed clinical characteristics and neuroimaging patterns of consecutive patients with who were admitted to our comprehensive stroke center for ESUS and underwent ILR insertion between August 1, 2019, and January 31, 202. The inclusion criteria were (1) 18 years of age or older; (2) classified as having cryptogenic stroke extracted from the group with undetermined stroke according to ESUS International Working Group; and (3) underwent ILR insertion during or after admission due to index ischemic events. Ischemic stroke pattern was classified as (1) tiny-scattered infarction, (2) whole-territorial infarction, (3) lobar infarction and (4) multiple-territorial infarction. Interrogations of data retrieved from the ILR were performed by cardiologists in every month after the implantation.ResultsIn this study, 41 ESUS patients who received an ILR implantation were enrolled (mean age, 64 years; male sex, 65.9%). The rate of AF detection at 6 months was 34% (14 patients), and the mean time from ILR insertion to AF detection was 52.5 days [interquartile range (IQR), 45.0–69.5]. The median initial NIH stroke scale scores were significantly greater in patients with AF than those without AF (6.5 vs. 3.0, p = 0.019). Whole-territorial infarction pattern was significantly more frequent in patients with AF than in those without AF (64.3% vs.11.1%, p = 0.002).ConclusionsHigher covert AF detection rates within the ESUS patients were most often associated with higher NIHSS and whole-territorial infarction patterns on brain imaging.

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Section: Discussionmentioning

confidence: 67%

Impact of Neuroimaging Patterns for the Detection of Atrial Fibrillation by Implantable Loop Recorders in Patients With Embolic Stroke of Undetermined Source

Kim

Boo²,

Kang³

et al. 2022

Front. Neurol.

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“…A retrospective study from Japan demonstrated that the AF detection rate was 26.2% during a median follow-up of 221.5 days [13]. Furthermore, recent retrospective observational ICM studies have demonstrated that major-vessel occlusion (n=84) and frequent premature atrial contractions (n=66) were associated with AF detection after adjustment for risk factors and commodities, respectively [11,12]. Based on the results of these previous studies, we decided to enroll 200 patients in this observational study in order to perform statistical analyses, including multivariate regression analysis, with su cient statistical power.…”

Section: Sample Sizementioning

confidence: 99%

Multicenter Observational Study on Detection of Atrial Fibrillation Using Insertable Cardiac Monitors in Patients With Cryptogenic Stroke in Japan : LOOK Registry - Study Design and Characteristics

Suda

Katano

Kitagawa

et al. 2021

Preprint

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Background Paroxysmal atrial fibrillation (AF) is a probable cause of cryptogenic stroke (CS) and AF detection and treatment are important for secondary prevention of stroke. Insertable cardiac monitors (ICMs) are clinically effective in screening for AF and superior to conventional CS follow-up. However, available data are primarily derived from small retrospective studies within Asian cohorts and there is a lack of detailed analyses of differences in patients with and without AF. In this study, we aim to identify the incidence of AF detection and risk stratification criteria within the LOOK (multicenter observational study on detection of atrial fibrillation using insertabLe cardiac mOnitors in patients with cryptOgenic stroKe) registry. Results may benefit patients with CS by enabling clinical practitioners to better predict occult AF and stroke via ICMs. Methods The LOOK registry is a multicenter, prospective, observational study evaluating the proportion, timing, and characteristics of AF detection in patients diagnosed with CS via ICMs. Patient enrolment in this ongoing study started in February 2020 with a target of 200 patients. We are investigating first detection of AF (lasting > 2 minutes) during follow-up at 6, 12, and 24 months via ICM implantation. Patient characteristics, medical history, serum biomarkers, magnetic resonance neuroimaging, atrial cardiomyopathy markers, electrocardiogram readings (including 24-hour Holter electrocardiogram readings), transesophageal echocardiography, cognitive status, stroke recurrence, and functional outcomes are compared between patients with and without AF in this study. Discussion This prospective, multicenter study aims to identify the current status of AF detection in CS patients in Japan. The findings of this study will help identify AF markers and generate a risk scoring system with a novel and superior screening algorithm for occult AF detection, while identifying candidates for ICM implantation and informing the development of diagnostic criteria for CS. Trial registration: UMIN000039809; Registered on 13 Mar 2020

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“…Further research on empiric anticoagulation is ongoing [ 14 ]. Recent investigations have strengthened the connection between AF and LVO [ 15 , 16 ]. In trials utilizing implantable and external cardiac monitors after cryptogenic stroke, the presence of LVO was the only independent predictor of AF besides age [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…Recent investigations have strengthened the connection between AF and LVO [ 15 , 16 ]. In trials utilizing implantable and external cardiac monitors after cryptogenic stroke, the presence of LVO was the only independent predictor of AF besides age [ 15 , 16 ]. These findings highlight the LVO subgroup of AIS and the need for detailed occult AF investigation.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Atrial Fibrillation in Large Vessel Occlusion and Large Embolic Stroke of Undetermined Source

Seachrist¹,

Petrone²,

Nevin³

et al. 2023

Cureus

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Introduction: Large vessel occlusion (LVO) stroke is a common presentation of acute ischemic stroke and is often unknown or cryptogenic in etiology. There is a strong association between atrial fibrillation (AF) and cryptogenic LVO stroke, making it a unique stroke subgroup. Therefore, we propose that any LVO stroke meeting the criteria for an embolic stroke of an undetermined source (ESUS) be classified as large ESUS (LESUS). The purpose of this retrospective cohort study was to report the etiology of anterior LVO strokes that underwent endovascular thrombectomy.Methods: This was a single-center retrospective cohort study characterizing the etiology of acute anterior circulation LVO strokes that received emergent endovascular thrombectomy from 2011 to 2018. Patients with LESUS designation at hospital discharge were changed to cardioembolic etiology if AF was discovered during the two-year follow-up period.Results: Overall, 155 (45%) of 307 patients in the study were found to have AF. New onset AF was discovered in 12 (23%) of 53 LESUS patients after hospitalization. Furthermore, eight (35%) of 23 LESUS patients who received extended cardiac monitoring were found to have AF. Conclusion:Nearly half the patients with LVO stroke who received endovascular thrombectomy were found to have AF. With the use of extended cardiac monitoring devices after hospitalization, AF is frequently discovered in patients with LESUS and may change the secondary stroke prevention strategy.

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

Cited by 14 publications

References 28 publications

Impact of Neuroimaging Patterns for the Detection of Atrial Fibrillation by Implantable Loop Recorders in Patients With Embolic Stroke of Undetermined Source

Impact of Neuroimaging Patterns for the Detection of Atrial Fibrillation by Implantable Loop Recorders in Patients With Embolic Stroke of Undetermined Source

Multicenter Observational Study on Detection of Atrial Fibrillation Using Insertable Cardiac Monitors in Patients With Cryptogenic Stroke in Japan : LOOK Registry - Study Design and Characteristics

Incidence of Atrial Fibrillation in Large Vessel Occlusion and Large Embolic Stroke of Undetermined Source

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