The Utility of Extended Electrocardiographic Monitoring for Detecting
Atrial Fibrillation in Cryptogenic Stroke in the African-American
population
Abstract
Introduction: Cryptogenic stroke comprises about 25% of all ischemic
strokes. Depending on modality and duration of ECG monitoring,
subclinical atrial fibrillation (AF) is detectable in 2.7-30% of
cryptogenic stroke patients. Hypothesis: Extended ECG monitoring after
cryptogenic stroke has not been studied in the African American (AA)
population. This retrospective study aims to study the incidence and
risk factors of subclinical AF in African Americans. Methods: We
retrospectively reviewed 96 patients who received implantable loop
recorders (ILR) for detecting subclinical atrial fibrillation after
cryptogenic stroke. In the vast majority of patients, the ILR was
implanted during index hospitalization. Binary univariate and
multivariate analyses were performed to determine predictors for AF
detection. Results: AF was detected in 29% of patients (28/96) at 1000
days. All AF that was detected was exquisitely paroxysmal and ranged in
duration between 0.05-103 minutes (mean 8.4 minutes with SD= 22.1
minutes). Binary univariate analysis revealed the use of
non-dihydropyridine calcium-channel blockers to be associated with
decreased odds of AF detection. Multivariate analysis found coronary
artery disease diagnosis to be associated with increased odds of AF
detection. Fifty percent of the events in the AF group were detected
within the first 36 days of loop recorder implantation. Conclusions: AF
detection in our population occurs very early after index stroke and at
significantly higher rates that reported before. Baseline
characteristics have a poor predictive ability for the detection of AF.
These findings emphasize the need for pre-discharge ILR implantation to
improve AF detection in all patients with cryptogenic stroke.