TY - JOUR
T1 - Paroxysmal atrial fibrillation in cryptogenic stroke
T2 - A case-control study
AU - Rabinstein, Alejandro A.
AU - Fugate, Jennifer E.
AU - Mandrekar, Jay
AU - Burns, Joseph D.
AU - Seet, Raymond C.S.
AU - Dupont, Stefan A.
AU - Kauffman, Timothy J.
AU - Asirvatham, Samuel J.
AU - Friedman, Paul A.
N1 - Funding Information:
Grant support: This study was supported by an unrestricted grant from CardioNet (Conshohocken, PA) .
PY - 2013/11
Y1 - 2013/11
N2 - Background: It is unclear if brief episodes of paroxysmal atrial fibrillation (PAF) detected by prolonged cardiac monitoring are an occult of cause of cryptogenic strokes (CS). We compared the incidence of PAF in patients with CS and patients with stroke of known cause (SKC) using prolonged ambulatory cardiac monitoring. Methods: We prospectively enrolled patients within 3 months of ischemic stroke to undergo noninvasive cardiac monitoring for 3 weeks. Primary end point was PAF detection independently confirmed by 2 blinded cardiologists. Results: The study consisted of 132 patients, 66 had CS and 66 had SKC. Episodes of PAF were detected in 16 of 64 (25%) patients with CS and 9 of 64 (14%) patients with SKC (P =.12). Duration and number of PAF episodes, PAF burden, and time of first PAF detection did not differ significantly between the 2 groups (P >.05 for all). In patients younger than 65 years, PAF was more common in the CS group (22% versus 3%; P =.07), whereas in patients 65 years or older, the rates of detection were similar (27% in CS versus 25% in SKC; P =.9). Among patients younger than 65 years with embolic imaging pattern, PAF was only observed in the CS group (21% versus 0%; P =.03). Conclusions: Very short episodes of PAF are common in patients with CS and with SKC, but their pathogenic significance is unclear. Predominance of PAF in younger patients with CS and embolic infarct pattern suggests a causative role in these cases. More research is needed before prolonged cardiac rhythm monitoring can be recommended to guide anticoagulation in CS patients.
AB - Background: It is unclear if brief episodes of paroxysmal atrial fibrillation (PAF) detected by prolonged cardiac monitoring are an occult of cause of cryptogenic strokes (CS). We compared the incidence of PAF in patients with CS and patients with stroke of known cause (SKC) using prolonged ambulatory cardiac monitoring. Methods: We prospectively enrolled patients within 3 months of ischemic stroke to undergo noninvasive cardiac monitoring for 3 weeks. Primary end point was PAF detection independently confirmed by 2 blinded cardiologists. Results: The study consisted of 132 patients, 66 had CS and 66 had SKC. Episodes of PAF were detected in 16 of 64 (25%) patients with CS and 9 of 64 (14%) patients with SKC (P =.12). Duration and number of PAF episodes, PAF burden, and time of first PAF detection did not differ significantly between the 2 groups (P >.05 for all). In patients younger than 65 years, PAF was more common in the CS group (22% versus 3%; P =.07), whereas in patients 65 years or older, the rates of detection were similar (27% in CS versus 25% in SKC; P =.9). Among patients younger than 65 years with embolic imaging pattern, PAF was only observed in the CS group (21% versus 0%; P =.03). Conclusions: Very short episodes of PAF are common in patients with CS and with SKC, but their pathogenic significance is unclear. Predominance of PAF in younger patients with CS and embolic infarct pattern suggests a causative role in these cases. More research is needed before prolonged cardiac rhythm monitoring can be recommended to guide anticoagulation in CS patients.
KW - Stroke
KW - cryptogenic
KW - paroxysmal atrial fibrillation
KW - prolonged monitoring
UR - http://www.scopus.com/inward/record.url?scp=84888993497&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84888993497&partnerID=8YFLogxK
U2 - 10.1016/j.jstrokecerebrovasdis.2013.05.013
DO - 10.1016/j.jstrokecerebrovasdis.2013.05.013
M3 - Article
C2 - 23791469
AN - SCOPUS:84888993497
SN - 1052-3057
VL - 22
SP - 1405
EP - 1411
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 8
ER -