Related Experiment Video
Updated: Sep 12, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Device-Detected Atrial Fibrillation in Patients With and Without Cryptogenic Ischemia: The ANTARCTICA Pooled Analysis
Shadi Yaghi1, Luciano A Sposato2, Liqi Shu1
1Department of Neurology, The Alpert Medical School of Brown University, Providence, RI (S.Y., L.S.).
Insights
Insertable cardiac monitoring (ICM) detects atrial fibrillation (AF) more frequently and faster in cryptogenic stroke or transient ischemic attack (C-IS/TIA) patients compared to others. This suggests a potentially pathogenic role for detected AF in C-IS/TIA cases.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Insertable cardiac monitoring (ICM) is used to detect atrial fibrillation (AF) in patients with cryptogenic stroke, noncryptogenic ischemic stroke, and nonstroke individuals at risk for AF.
- Patient characteristics vary across studies, potentially leading to unexamined differences in AF detection rates by ICM.
- Investigating AF detection rates in specific patient subgroups is crucial for understanding the utility of ICM.
Purpose of the Study:
- To compare AF detection rates using ICM between patients with cryptogenic stroke or transient ischemic attack (C-IS/TIA) and those without stroke or with noncryptogenic stroke.
- To determine if C-IS/TIA is associated with a higher likelihood of AF detection via ICM.
- To assess the time to AF detection in C-IS/TIA patients versus other groups.
Main Methods:
- An individual-participant data meta-analysis was conducted, pooling data from prospective studies and randomized controlled trials of ICM.
- Multilevel multivariable logistic regression models were employed to analyze the association between C-IS/TIA and AF detection.
- Multiple imputation was used for missing data (<20%), and Rubin's rules combined results from 100 imputed datasets to estimate adjusted odds ratios.
Main Results:
- The analysis included 1562 C-IS/TIA patients and 474 non-C-IS/TIA patients from 14 studies (2 RCTs, 12 prospective).
- AF detection was significantly higher in C-IS/TIA patients (adjusted odds ratio, 1.90; P=0.009), with 47% of detected AF considered potentially pathogenic.
- Time to AF detection was substantially shorter in C-IS/TIA patients (median 65 days) compared to non-C-IS/TIA patients (median 169 days; P<0.001).
Conclusions:
- Patients with C-IS/TIA exhibit higher AF detection rates and shorter times to detection using ICM compared to noncryptogenic/nonstroke individuals.
- The findings suggest that AF detected in C-IS/TIA patients may be pathogenic, underscoring the importance of ICM in this population.
- This meta-analysis provides robust evidence supporting the use of ICM for diagnosing AF in cryptogenic stroke/TIA.
Background:
Insertable cardiac monitoring (ICM) detects atrial fibrillation (AF) in substantial proportions of cryptogenic stroke, noncryptogenic ischemic stroke without known AF, and nonstroke patients who are at risk of underlying AF. Given differences in patient characteristics across studies, there may be differences in AF detection rates on ICM across these subgroups that have not been identified. We investigate whether AF detection rates on ICM are higher in cryptogenic stroke or transient ischemic attack (C-IS/TIA) patients compared with individuals with noncryptogenic stroke or without stroke, when accounting for differences in study populations.
Methods:
This is an individual-participant data meta-analysis of prospective studies and randomized controlled trials of ICM in C-IS/TIA, noncryptogenic ischemic stroke, and nonstroke patients. Multilevel multivariable logistic regression models were used to test whether C-IS/TIA is associated with increased AF detection relative to other categories. We performed multiple imputation to derive values for variables with <20% missing data and used Rubin's rules to estimate adjusted odds ratios by combining 100 postimputation data sets. The primary outcome was detection of AF. The attributable risk was derived by application of Bayes' Theorem.
Results:
Two randomized controlled trials and 12 prospective studies were included with a total of 1562 C-IS/TIA patients and 474 non-C-IS/TIA patients. In adjusted multilevel logistic regression analyses, AF detection was higher in C-IS/TIA patients (adjusted odds ratio, 1.90 [95% CI, 1.18-3.06]; P=0.009), indicating that 47% of AF detected in C-IS/TIA is pathogenic. Limiting the comparator group to ischemic stroke or history of stroke yielded similar results (adjusted odds ratio, 2.83 [95% CI, 1.47-5.44]; P=0.002). Days to AF detection were significantly shorter in C-IS/TIA patients (median 65 versus 169; P<0.001).
Conclusions:
In this individual-participant data meta-analysis of patients undergoing ICM, AF detection was higher in C-IS/TIA patients, with shorter time to AF detection compared with noncryptogenic/nonstroke individuals. These findings suggest that some of the AF detected in patients with C-IS/TIA may be pathogenic.
More Related Videos
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
01:29Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies