Abstract P630: Detection of Atrial Fibrillation by Prolonged Cardiac Monitoring in Cryptogenic and Known Stroke Etiology

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Michal krawczyk ◽  
Sebastián Fridman ◽  
Maria Bres Bullrich ◽  
Palak Shah ◽  
Juan C Vargas-Gonzalez ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Cryptogenic Stroke ◽  
Left Atrial Volume ◽  
Cardiac Monitoring ◽  
Volume Index ◽  
Multivariate Logistic Regression Model ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Therapeutic Decisions

Introduction: Approximately 25% of strokes are classified as cryptogenic (CS), while greater than 50% have an identifiable or ‘known’ etiology (KS). Several studies have demonstrated that prolonged cardiac monitoring (PCM) after cryptogenic stroke substantially increases the detection of atrial fibrillation (AF), but the yield of PCM in KS stroke is unknown. As a result, the majority of guidelines recommend restricting PCM to patients with cryptogenic stroke. If the detection of AF in KS is no different to cryptogenic stroke, it would suggest that this group too would similarly benefit from PCM, with the potential to impact therapeutic decisions (e.g. initiating anticoagulation). Methods: In a cross-sectional study, we compared AF detection by PCM (minimum of 48 hrs) between CS and KS patients without a previous diagnosis of AF. We developed a multivariate logistic regression model by including known and significant clinical, echocardiographic, and radiological factors known to be associated with the detection of AF. We reported results as odds ratios (OR) and 95% confidence intervals (95% CI). Results: We included 561 ischemic stroke patients, 376 with CS and 185 with KS. The median duration of PCM was 167h for CS and 48h for KS. AF was detected in 30 of 376 (8%) CS patients, and 20 of 185 (7.9%) KS patients. Age, history of thyroid disease, clinical presentation of dysarthria, wake-up stroke, and left atrial volume index on echocardiography were significantly associated with a new diagnosis of AF after stroke in the univariable analysis and were thus included in the logistic regression analysis. Additionally, duration of PCM was included in the multivariate model. After adjustment for potential confounders, AF detection by PCM was not significantly higher for CS than KS (OR 0.95, 95% CI 0.25-3.32, P=0.94). Conclusion: To the best of our knowledge this is the first study directly comparing the incidence of AF between CS and KS as the pre-specified primary outcome. Our findings suggest that CS and KS patients have similar rates of AF detection by PCM. Future prospective research is required to confirm these findings and to determine the cost-effectiveness of PCM in non-cryptogenic stroke patients.

scholarly journals B-PO01-028 UTILIZATION OF CARDIAC MONITORING FOR ATRIAL FIBRILLATION IN CRYPTOGENIC STROKE PATIENTS

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S62
Author(s):  
Matthew R. Reynolds ◽  
Candace L. Gunnarsson ◽  
Michael P. Ryan ◽  
Sarah Rosemas ◽  
Paul D. Ziegler ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Cardiac Monitoring ◽  
Stroke Patients

Abstract P624: High Detection of Atrial Fibrillation by 90 Days Textil Holter Monitoring in Patients With Cryptogenic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jorge Pagola ◽  
Jesus Juega ◽  
Jaume Francisco ◽  
Maite Rodriguez ◽  
Juan Antonio Cabezas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cumulative Incidence ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Left Atrial Volume ◽  
Holter Monitoring ◽  
Cardiac Monitoring ◽  
Atrial Volume ◽  
Monitoring Time ◽  
Number Of Patients

Introduction: External recorders allow for low-cost, non-invasive 1 to 4 weeks monitoring. However, the first 3 months of monitoring duration are the most effective to detect atrial fibrillation (AF). We show the results of the Thunder registry of patients monitored to detect AF during 90 days from the stroke. Methods: A prospective observational study was conducted with consecutive inclusion of patients with cryptogenic stroke after work up (neuroimaging, echocardiography and 24-hour cardiac monitoring) in 5 Comprenhensive Stroke Centers. Patients were continuously monitored for 90 days with a wearable Holter (Nuubo®) after the first 24 hours of the stroke onset. We analyzed the percentage of AF detection in each period (percentage of AF among those monitored), the quality of the monitoring (monitoring time), the percentage of AF by intention to monitor (detection of AF among patient included). Demographic, clinical and echocardiographic predictors of AF detection beyond one week of cardiac monitoring were assessed. Results: A total of 254 patients were included. The cumulative incidence of AF detection at 90 days was 34.84%. The monitoring time was similar among the 3 months (30 days: 544.9 hours Vs 60 days: 505.9 hours Vs 90 days: 591.25 hours) (p=0.512). The number of patients who abandoned monitoring was 7% (18/254). The cumulative percentage of intention to detect AF was 30.88% (Figure). Patients who completed monitoring beyond 30 days had higher score on the NIHSS basal scale (NIHSS 9 IQR 2-17) VS (NIHSS 3 IQR 1-9) (p=0.024). Patients with left atrial volume greater than 28.5ml/m2 had higher risk of cumulative incidence of AF according to the Kaplan Meyer curve beyond the first week of monitoring OR 2.72 (Log-rank (Mantel-Cox test) (p<0.001). Conclusions: In conclusion, intensive 90-day- Holter monitoring with textile Holter was feasible and detected high percentage of AF. Enlarged left atrial volume predicted AF beyond the first week of monitoring.

Abstract 15257: Epicardial and Peri-atrial Fat Attenuation Predict Recurrence in Patients Undergoing Repeat Catheter Ablation for Refractory Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mark S Brahier ◽  
Fengwei Zou ◽  
Frank Migliarese ◽  
Milos Tomovic ◽  
Alexandra Taylor ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Adipose Tissue ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Epicardial Fat ◽  
Volume Index ◽  
Atrial Volume ◽  
Af Recurrence

Background: Identifying factors predictive of atrial fibrillation (AF) recurrence after catheter ablation (CA) can improve patient selection. It has been hypothesized that inflammatory paracrine signaling by metabolically active adipose tissue induces pathologic changes in surrounding cardiovascular tissue. In fact, fat attenuation on CT has been previously associated with AF recurrence after de novo CA. The purpose of this study was to investigate the predictive qualities of epicardial and peri-atrial adipose tissue in a population undergoing repeat CA. We hypothesized that higher epicardial and left peri-atrial fat attenuation would predict recurrence as markers of increased localized inflammation. Methods: The study population consisted of 84 patients with symptomatic, drug and ablation-refractory AF undergoing repeat CA. All patients had a pre-ablation, contrast-enhanced cardiac CT, which was analyzed for mean fat attenuation in Hounsfield units (HU) and left atrial volume using the post-processing program 3D Slicer. Patients were followed for recurrence of atrial tachyarrhythmias after a 3-month blanking period. We performed logistic regression to adjust for age, sex, BMI, hypertension, smoking history, diabetes, obstructive sleep apnea, and left atrial volume index. Results: Repeat CA patients with recurrence (n=52) had a higher epicardial fat attenuation (-84.8 ±5.6 vs -88.1 ±5.2 HU; p=0.009) and peri-atrial fat attenuation (-81.0 ±4.7 vs -83.2 ±4.3 HU; p=0.036) than those without recurrence (n=32) at a mean follow-up period of 26 ±18 months. Logistic regression analysis showed that epicardial fat attenuation (OR 1.21; p=0.005) and peri-atrial fat attenuation (OR 1.27; p=0.007) are predictive of AF recurrence independent of traditional risk factors. Conclusions: Epicardial and left peri-atrial adipose attenuation are predictive of recurrence in patients undergoing repeat CA for AF.

Frequent Premature Atrial Contractions in Cryptogenic Stroke Predict Atrial Fibrillation Detection with Insertable Cardiac Monitoring

2020 ◽  
Vol 49 (2) ◽  
pp. 144-150 ◽  
Author(s):  
Kenichi Todo ◽  
Tomonori Iwata ◽  
Ryosuke Doijiri ◽  
Hiroshi Yamagami ◽  
Masafumi Morimoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Frequency ◽  
Strong Predictor ◽  
Cryptogenic Stroke ◽  
High Plasma ◽  
Cardiac Monitoring ◽  
Stroke Patients ◽  
Chads2 Score ◽  
Index Stroke

Objective: To determine whether frequent premature atrial contractions (PAC) predict atrial fibrillation (AF) in cryptogenic stroke patients, we analyzed the association between frequent PACs in 24-h Holter electrocardiogram recording and AF detected by insertable cardiac monitoring (ICM). Methods: We retrospectively analyzed a database of 66 consecutive patients with cryptogenic stroke who received ICM implantation between October 2016 and March 2018 at 5 stroke centers. We included the follow-up data until June 2018 in this analysis. We defined frequent PACs as the upper quartile of the 66 patients. We analyzed the association of frequent PACs with AF detected by ICM. Results: Frequent PACs were defined as >222 PACs per a 24-h period. The proportion of patients with newly detected AF by ICM was higher in patients with frequent PACs than those without (50% [8/16] vs. 22% [11/50], p < 0.05). Frequent PACs were associated with AF detection and time to the first AF after adjustment for CHADS2 score after index stroke, high plasma ­B-type natriuretic peptide (BNP; >100 pg/mL) or serum ­N-terminal pro-BNP levels (>300 pg/mL), and large left atrial diameter (≥45 mm). Conclusion: High frequency of PACs in cryptogenic stroke may be a strong predictor of AF detected by ICM.

Abstract MP77: Associations Between Atrial Cardiopathy and Cerebral Amyloid: The Aric Pet Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Michelle C JOHANSEN ◽  
Thomas Mosley ◽  
David Knopman ◽  
Dean Wong ◽  
Lynne E Wagenknecht ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Standardized Uptake Value ◽  
Left Atrial Volume ◽  
Community Dwelling ◽  
P Wave ◽  
Volume Index ◽  
Older Individuals ◽  
Cross Sectional ◽  
2D Echocardiography

Background: Atrial fibrillation (AF) is a risk factor for cognitive decline, perhaps due to silent cerebral infarction, but it is unknown if it also acts on Alzheimer’s Disease (AD)-specific mechanisms, such as deposition of β-amyloid (Aβ). Left atrial changes in structure or function, or atrial cardiopathy, can lead to AF but may cause infarcts independently, and thus might also impact cognition. We hypothesize that Aβ is associated with AF and atrial cardiopathy, independent of AF, when defined similarly to an ongoing clinical trial (ARCADIA). Methods: 321 participants without dementia from the Atherosclerosis Risk in Communities study underwent florbetapir (FBP) PET, electrocardiogram and 2D echocardiography. Atrial cardiopathy was defined as ≥1 of: 1) left atrial volume index (LAVI) >34 ml/m2; 2) P-wave terminal force >5000 uV x ms and 3) serum NT proBNP>250 pg/mL. Cross-sectional associations between global cortical Aβ (>1.2 standardized uptake value ratio (SUVR)) and adjudicated history of atrial fibrillation and atrial cardiopathy, each, were evaluated using multivariable logistic regression. Results: Participants, with mean age 76 y, were 56% female and 42% black. Odds of elevated FBP SUVR was increased for those with atrial cardiopathy (Model 3) and nearly doubled among those with enlarged LAVI that remained significant after sequential adjustment, including AF (Table). There was no significant association between either P-wave terminal force or NT proBNP and elevated FBP SUVR (Table), nor between elevated SUVR and AF. Conclusions: In this cross-sectional analysis of a cohort of healthy, nondemented community-dwelling older individuals, we report a significant association between atrial cardiopathy as well as LAVI and elevated amyloid, by PET, without a similar association in individuals with AF. Potential limitations include reverse causation and survival bias. Ongoing work will help determine if changes in cardiac structure and function precede, or occur simultaneously with amyloid deposition.

scholarly journals Presence of Atrial Fibrillation in Stroke Patients With Patent Foramen Ovale: Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Jessie Ze-Jun Chen ◽  
Vincent N. Thijs
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Confidence Interval ◽  
Lower Risk ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Stroke Patients ◽  
Loop Recorder ◽  
Cross Sectional

Purpose: Patent foramen ovale (PFO) is associated with ischemic stroke, especially in patients with embolic stroke of undetermined source. This study aims to evaluate the presence of atrial fibrillation (AF) in ischemic stroke patients with PFO.Methods: We systematically searched EMBASE and MEDLINE databases on May 21, 2020 for studies that analyzed the presence of AF in patients with PFO. The primary outcome was the presence of AF in patients with PFO compared with those without. Outcomes were pooled using a random-effects model using the method of DerSimonian and Laird. We recorded demographic characteristics and the methods used for AF detection in the studies included (unspecified, history/medical records review, ECG, Holter monitor, or loop recorder).Results: A total of 14 studies and 13,245 patients fulfilled the entry criteria. The average age was 61.2 years and 41.3% of the participants were female. There was a lower risk of AF in patients with PFO compared with those without (RR 0.52, 95% confidence interval, 0.41–0.63, p &lt; 0.001). There was no evidence of heterogeneity. The lower risk of AF was found in cross-sectional and longitudinal studies and in studies stratified by average age (&lt;60 or ≥60) and in cryptogenic stroke. Meta-regression by PFO detection technique suggested that studies using transoesophageal echocardiogram for PFO detection reported higher risk of AF (1.39, 95% confidence interval 1.14–1.70, p = 0.004).Conclusion: The presence of a PFO in patients with ischemic stroke/TIA may be associated with a lower risk of AF. Few studies have estimated the risk of future AF in patients with PFO.

Abstract WP255: Can Normal Electrocardiogram Rule Out Newly Diagnosed Atrial Fibrillation in Ischemic Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Joshua Santucci ◽  
Takashi Shimoyama ◽  
Ken Uchino
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cryptogenic Stroke ◽  
Cardiac Monitoring ◽  
Large Artery ◽  
Newly Diagnosed ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
History Of

Introduction: Electrocardiogram (ECG) findings of premature atrial contraction and prolonged PR interval are associated with risk of onset atrial fibrillation (AF) in cryptogenic stroke. We sought to see if normal ECG and AF incidence is incompletely understood. Methods: From a prospective single-hospital stroke registry from 2018, we identified ischemic stroke patients who had ECG done on admission for review. We excluded patients with AF on admission ECG, history of AF, and implanted device with cardiac monitoring capability. Normal ECG was interpreted based on the standardized reporting guidelines for ECG studies evaluating risk stratification of emergency department patients. Stroke subtype was diagnosed according to the TOAST classification: large artery atherosclerosis (LAA), small vessel occlusion (SVO), cardioembolism, others/undetermined and embolic stoke of undetermined source (ESUS) criteria. We compared the incidence of newly diagnosed AF during hospitalization and from outpatient cardiac event monitoring between normal and abnormal ECG. Results: Of the 558 consecutive acute ischemic stroke patients, we excluded 135 with AF on admission ECG or history of AF and 9 with implanted devices. Of the remaining 414 patients that were included in the study, ESUS (31.2%) was the most frequent stroke subtype, followed by LAA (30.0%), SVO (14.0%), others/undetermined (15.7%), and cardioembolism (9.2%). Normal ECG was observed in 125 patients (30.2%). Cardioembolic subtype was less frequent in the normal versus abnormal ECG group (1.6% vs. 12.5%, p<0.001). New AF was detected in 17/414 patients (4.1%) during hospitalization. Of these 17 patients, none had normal ECG (0/125) and all had abnormal ECG (17/289, 5.9%) (p=0.002). After discharge, of 111 patients undergoing 4-week outpatient cardiac monitoring, new AF was detected in 16 (14.4%). Of these 16 patients, only 1 had a normal ECG (1/35, 2.9%) while 15 had abnormal ECG (15/76, 19.7%) (p=0.02). Conclusions: Normal ECG at admission for acute ischemic stroke is associated with low likelihood of detection of new atrial fibrillation in either the inpatient or outpatient setting.

Abstract WP256: Atrial Fibrillation Predicting Factors in Transient and Minor Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Marian Muchada Lopez ◽  
Jorge Pagola ◽  
Jesus Juega ◽  
Jaume Francisco-Pascual ◽  
Alejandro Bustamante ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Volume Index ◽  
Minor Stroke ◽  
Stroke Patients ◽  
Left Atrial Strain ◽  
Minor Ischemic Stroke ◽  
Atrial Strain

Introduction and Purpose: Our aim was to review the characteristics of transient ischemic attack (TIA) and minor ischemic stroke patients monitored for atrial fibrillation (AF) epidoses detection within the first 4weeks after stroke to assess AF predictors. Materials and Methods: TIA and minor ischemic stroke patients (nihss≤ 5) were selected from CRYPTO-AF database. CRYPTO-AF is a prospective multicentre registry of patients with cryptogenic stroke older of 55 year-old. Monitoring started within the first 72 hours from stroke symptoms onset and was prolonged for 4 weeks. Clinical, cardiographic and blood test parameters of patients included were reviewed. Fisher exact and Mann Whitney tests were used to analyze categorical and continuous data. Results: In our cohort of 152 transient and minor ischemic stroke patients, 55.9% were men, mean age 73.18±10.24 and median NIHSS score was 2.31(0-5). A total of 30 patients (20.3%) were diagnosed with AF in the first month of monitoring, 6 patients (5.7%) within the first 3 days, 14 patients (13.3%) between 3 days and to 2 weeks of monitoring, and 14 partientes (12.4%) between the second and the fourth week. In these transient and minor ischemic stroke patients, age (p< 0.031), left atrial volume index (p< 0.023), the appearance of isolated extrasystoles during monitoring (p< 0.021), Type B natriuretic peptide (p< 0.011) and the longitudinal strain (p< 0.019) appeared as independet precitors of AF. However in the multivariate analysis adjusted for the above variables, only left atrial strain (OR 0.89, 95% CI: 0.797-0.991, p< 0.034) independently predicts AF detection. Conclusions: In our serie, only the left atrial strain appeared as a indepent predictor of AF. Given the known pathophysiology of TIA and minor ischemic stroke, the description of AF predictors would help to identify those patients who would benefit from completing a longer monitoring. More studies are needed to identify these predictors.

Sign in / Sign up

Export Citation Format

Share Document