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Updated: Mar 31, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Insertable cardiac monitors after cryptogenic stroke--a risk factor based approach to enhance the detection rate for
S Poli1, J Diedler1, F Härtig1
1Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
Insights
Selecting patients with atrial fibrillation (AF) risk factors for insertable cardiac monitors (ICMs) after cryptogenic stroke or TIA significantly increases AF detection rates. Left atrial dilation and atrial runs independently predict AF occurrence.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Cryptogenic stroke and transient ischemic attack (TIA) patients have a high risk of undetected atrial fibrillation (AF).
- Previous studies like CRYSTAL AF showed significant AF detection rates using insertable cardiac monitors (ICMs).
Purpose of the Study:
- To evaluate if pre-selecting patients with AF risk factors enhances AF detection rates via ICMs.
- To identify specific AF risk factors that predict AF detection in cryptogenic stroke/TIA patients.
Main Methods:
- Seventy-five patients with cryptogenic stroke/TIA and at least one AF risk factor (CHA2DS2-VASc score ≥4, atrial runs, LA size >45 mm, LAA flow ≤0.2 m/s, or spontaneous echo contrast) were enrolled.
- Patients underwent ICM implantation to monitor for AF episodes (≥2 min).
Main Results:
- AF was detected in 33.3% of patients after 12 months of ICM monitoring.
- The majority (92%) of detected AF episodes were asymptomatic.
- Left atrial size >45 mm and atrial runs were independently associated with increased AF detection.
Conclusions:
- Selecting ICM candidates based on AF risk factors increases AF detection to one-third in cryptogenic stroke/TIA patients within a year.
- Left atrial dilation and atrial runs are significant independent predictors of AF detection in this population.
Background And Purpose:
Recently, the CRYSTAL AF trial detected paroxysmal atrial fibrillation (AF) in 12.4% of patients after cryptogenic ischaemic stroke (IS) or cryptogenic transient ischaemic attack (TIA) by an insertable cardiac monitor (ICM) within 1 year of monitoring. Our aim was (i) to assess if an AF risk factor based pre-selection of ICM candidates would enhance the rate of AF detection and (ii) to determine AF risk factors with significant predictive value for AF detection.
Methods:
Seventy-five patients with cryptogenic IS/TIA were consecutively enrolled if at least one of the following AF risk factors was present: a CHA2DS2-VASc score ≥4, atrial runs, left atrium (LA) size >45 mm, left atrial appendage (LAA) flow ≤0.2 m/s, or spontaneous echo contrast in the LAA. The electrocardiographic and echocardiographic criteria were chosen as they have been repeatedly reported to predict AF; the same applies for four of the six items of the CHA2DS2-VASc score. The study end-point was the detection of one or more episodes of AF (≥2 min).
Results:
Seventy-four patients underwent implantation of an ICM; one patient had AF at the date of implantation. After 6 months, AF was detected in 21/75 patients (28%), after 12 months in 25/75 patients (33.3%). 92% of AF episodes were asymptomatic. LA size >45 mm and the presence of atrial runs were independently associated with AF detection [hazard ratio 3.6 (95% confidence interval 1.6-8.4), P = 0.002, and 2.7 (1.2-6.7), P = 0.023, respectively].
Conclusions:
The detection rate of AF is one-third after 1 year if candidates for an ICM after cryptogenic IS/TIA are selected by AF risk factors. LA dilation and atrial runs independently predict AF.
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