By Matthew E. Fink, MD
Louis and Gertrude Feil Professor in Clinical Neurology and Chairman, Department of Neurology, Weill Cornell Medical College; Neurologist-in-Chief, New York Presbyterian Hospital; Professor and Chairman, Department of Neurology, Weill Cornell Medical College, Neurologist-in-Chief, New York Presbyterian Hospital
Dr. Fink reports no financial relationships relevant to this field of study.
SOURCE: Favilla CG, et al. Predictors of finding occult atrial fibrillation after cryptogenic stroke. Stroke 2015;46:1210-1215.
In large, prospective databases of ischemic stroke, cryptogenic stroke occurs in as many as 30% of all ischemic stroke patients. Many of these patients have the characteristics of cardioembolic stroke, and there has always been a strong suspicion that some of these patients have atrial fibrillation (AF). However, only about 5% of patients with acute ischemic stroke are found to have AF while inpatients. Therefore, there is great interest in performing mobile cardiac outpatient telemetry (MCOT) after discharge, and this study looked at a retrospective cohort of consecutive patients who underwent 28-day MCOT after discharge.
There were 227 patients with cryptogenic stroke (179) or transient ischemic stroke (48), and 14% had AF detected on MCOT. In a multivariate analysis of clinical, echocardiographic, and radiographic features associated with the strokes, the only significant independent predictors of finding paroxysmal AF were age > 60 years (odds ratio [OR] = 3.7) and prior cortical or cerebellar infarction seen on neuroimaging (OR = 3).
No other clinical features, including demographics, CHADS2 score, congestive heart failure, hypertension, age, diabetes, prior stroke or transient ischemic attack, vascular disease, sex, or stroke symptoms, were significant predictors, nor did electrocardiographic findings or radiographic characteristics of the acute infarction have any significant association with the detection of paroxysmal AF.
Therefore, these results would support monitoring patients > 60 years of age with evidence of prior stroke on brain imaging to look for AF. In this series, AF was detected in 33% of patients who had both of these features, but in only 4% of patients with neither.