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Paroxysmal atrial fibrillation occurs often in cryptogenic ischaemic stroke. Final results from the SURPRISE study

L M Christensen1, D W Krieger, S Højberg

  • 1Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospitals, Copenhagen, Denmark.

European Journal of Neurology
|March 18, 2014
PubMed

Insights

One in five cryptogenic stroke patients had asymptomatic paroxysmal atrial fibrillation (PAF) detected by long-term monitoring. This AF often occurred long after the stroke, suggesting a need for extended cardiac surveillance.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Devices

Background:

  • Atrial fibrillation (AF) significantly increases stroke risk and is linked to poor outcomes.
  • Cryptogenic stroke (CS) accounts for up to one-third of strokes despite guideline-compliant work-up.
  • The prevalence of asymptomatic paroxysmal atrial fibrillation (PAF) in CS patients is largely unknown.

Purpose of the Study:

  • To determine the rate of asymptomatic PAF in patients with cryptogenic stroke.
  • To evaluate the utility of long-term cardiac monitoring for detecting PAF in this population.

Main Methods:

  • Inclusion of 85 CS patients post-standard work-up.
  • Subcutaneous implantation of an implantable loop recorder (ILR) for cardiac monitoring.
  • Definition of PAF as atrial arrhythmia >2 minutes with ECG confirmation.

Main Results:

  • 18 patients (20.7%) were diagnosed with PAF during a mean follow-up of 569 days.
  • ILR detected PAF in 14 patients (16.1%); PAF was asymptomatic in all cases.
  • Recurrent strokes occurred in 4 patients, 3 of whom had documented PAF while on oral anticoagulation (OAC).

Conclusions:

  • Approximately 20% of CS patients harbor asymptomatic PAF, often detected long after the initial stroke.
  • Implantable cardiac monitors may play a crucial role in diagnosing PAF post-stroke.
  • Further research is needed to assess the therapeutic benefit of OAC in PAF patients following stroke.
Abstract

Keywords:
atrial fibrillationcardiologycryptogenic strokeimplantable loop recorderlong-term cardiac monitoringneurologyparoxysmal atrial fibrillation

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