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• W4377015551 abstract "Detection of occult AF using implantable loop recorders (ILR) has become routine practice in the evaluation of cryptogenic stroke, yet there are few data demonstrating that ILRs reduce risk of recurrent stroke. Our aim was to determine if the diagnostic yield for ILR-detected AF in patients with cryptogenic stroke may be improved using clinical characteristics, and if ILR-directed changes in medical therapy reduce risk of recurrent stroke. We observed 282 consecutive patients with cryptogenic stroke (n=255) or transient ischemic attack (TIA, n=27) implanted with ILR at an academic stroke center for the clinical outcomes of first detected AF, recurrent stroke or TIA, and the temporal relation between AF and recurrent stroke/TIA. Collected data included demographics, comorbid medical conditions, stroke and imaging details, ECG and echocardiographic findings, and routine laboratory testing. During 557 days median follow-up, 50 (18%) patients manifested AF after a median 107 days, including 15% at 1 year, 20% at 2 years, and 23% at 3 years. All but 1 patient were started on a direct anticoagulant (n=48) or warfarin (n=1) upon AF diagnosis. Age (HR 1.04 per year, 95% CI 1.02-1.07; p<0.001) and middle cerebral artery stroke (HR 2.20, 95% CI 1.06-4.58; p=0.035) were independently associated with shorter time to first detected AF. Only 2 of 20 patients with recurrent stroke (n=17) or TIA (n=3) had ILR-detected AF; in both cases AF was first seen >1 year after recurrent stroke or TIA despite continuous monitoring. Age 65-years old best delineated risk of detected AF (area under ROC curve 0.66, p<0.001). Among 157 patients <65 years old, only 13 (8%) had AF; all had left ventricular end-diastolic dimension >4.60 cm (median LVEDD 4.90) and cortical stroke. Among 125 patients ≥65 years old, 37 (30%) had AF; mitral regurgitation (HR 1.98, 95% CI 1.06-3.72; p=0.03) was independently associated with shorter time to first AF detection. Detection of AF after cryptogenic stroke is highest within the first year of ILR monitoring. Consideration of age, stroke territory, and mitral valvular disease increases specificity for detecting AF and thus informs who should receive ILR. Correlation between recurrent AF and recurrent stroke or TIA is poor, raising concern that routine ILR use may not prevent additional strokes." @default.
• W4377015551 created "2023-05-19" @default.
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• W4377015551 date "2023-05-01" @default.
• W4377015551 modified "2023-10-01" @default.
• W4377015551 title "PO-03-048 CLINICAL UTILITY OF IMPLANTABLE LOOP RECORDERS AFTER CRYPTOGENIC STROKE: INSIGHTS FROM A LARGE ACADEMIC STROKE CENTER" @default.
• W4377015551 doi "https://doi.org/10.1016/j.hrthm.2023.03.1051" @default.
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