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Atrial fibrillation in cryptogenic stroke and TIA patients in The Nordic Atrial Fibrillation and Stroke (NOR-FIB)

B Ratajczak-Tretel1,2, A Tancin Lambert1,2, R Al-Ani3

  • 1Department of Neurology, Østfold Hospital Trust, Grålum, Norway.

European Stroke Journal
|April 6, 2023
PubMed

Insights

The NOR-FIB study found that insertable cardiac monitors (ICMs) effectively detected atrial fibrillation (AF) in nearly 29% of cryptogenic stroke and TIA patients. This crucial diagnosis, often asymptomatic, enables timely secondary stroke prevention with anticoagulants.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Devices

Background:

  • Secondary stroke prevention requires identifying the cause and initiating prompt treatment.
  • Cryptogenic stroke (CS) and transient ischemic attack (TIA) necessitate thorough etiological investigation.
  • Atrial fibrillation (AF) is a common, often asymptomatic, cause of stroke that requires detection for effective management.

Purpose of the Study:

  • To evaluate the efficacy of insertable cardiac monitors (ICMs) in detecting atrial fibrillation (AF) in patients with CS or TIA.
  • To assess the feasibility of ICM use by stroke physicians for optimizing secondary stroke prevention.
  • To quantify the rate of AF detection and its characteristics in this patient cohort.

Main Methods:

  • Prospective observational international multicenter real-life study.
  • 259 patients with CS or TIA were monitored for 12 months using ICM (Reveal LINQ) for AF detection.
  • ICM insertion was performed by stroke physicians within a median of 9 days post-event.

Main Results:

  • Paroxysmal AF was diagnosed in 74 out of 259 patients (28.6%), with detection occurring early after ICM insertion.
  • AF patients were older, had higher CHA₂DS₂-VASc scores, and more comorbidities than non-AF patients.
  • The arrhythmia was recurrent in 91.9% and asymptomatic in 93.2%; 97.3% of AF patients received anticoagulants at 12-month follow-up.

Conclusions:

  • ICM is an effective tool for diagnosing underlying AF in CS and TIA patients, capturing AF in 29% of cases.
  • AF detected by ICM is often asymptomatic, highlighting the need for continuous monitoring.
  • ICM insertion and utilization are feasible for stroke physicians in stroke units, aiding secondary stroke prevention.
Abstract

Keywords:
Cryptogenic strokeanticoagulationarrhythmia monitoringatrial fibrillationbiomarkersinsertable cardiac monitorsecondary prevention

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