Related Experiment Video

Updated: Aug 21, 2025

Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
08:10

Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation

Published on: July 20, 2022

1.8K

Multiparametric identification of subclinical atrial fibrillation after an embolic stroke of undetermined source

Alvise Del Monte1, Francesco Rivezzi1, Enrico Giacomin1

  • 1Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Forcellini, 209/d, Padua, Italy.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|November 16, 2022
PubMed

Insights

Subclinical atrial fibrillation (SCAF) detection in embolic stroke of undetermined source (ESUS) patients is crucial for secondary prevention. A multiparametric evaluation accurately predicts SCAF, aiding in identifying candidates for implantable cardiac monitors (ICM).

Area of Science:

  • Cardiology
  • Neurology
  • Medical Devices

Background:

  • Subclinical atrial fibrillation (SCAF) is a potential cause of embolic stroke of undetermined source (ESUS).
  • Early SCAF detection is vital for secondary stroke prevention through anticoagulation.
  • Implantable cardiac monitors (ICMs) are indicated for SCAF detection.

Purpose of the Study:

  • To evaluate the frequency of SCAF detected by ICM in ESUS patients.
  • To identify predictors of SCAF in this population.
  • To determine which patients would most benefit from ICM implantation.

Main Methods:

  • A prospective study included 109 ESUS patients without prior atrial fibrillation history, implanted with ICMs between February 2017 and November 2020.
  • SCAF was defined as >2 minutes of irregularly irregular rhythm without distinct P waves on ICM electrogram.
  • Predictors of SCAF were analyzed using Cox regression, and ROC curves assessed predictive accuracy.

Main Results:

  • SCAF was detected in 33% of patients during a median follow-up of 19.2 months.
  • Independent predictors for SCAF included abnormal P wave terminal force in V1, left atrial end-systolic volume >34 ml/m², and BMI >25 kg/m².
  • A combination of these three parameters achieved 74% accuracy in predicting SCAF detection.

Conclusions:

  • Multiparametric evaluation offers the highest accuracy for predicting SCAF in ESUS patients.
  • This approach can help identify patients most likely to benefit from ICM implantation for SCAF detection and secondary stroke prevention.
Abstract

Keywords:
Atrial fibrillationElectrocardiographic predictorsEmbolic stroke of undetermined sourceImplantable cardiac monitor

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