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Detection of atrial fibrillation using an implantable loop recorder in patients with previous cryptogenic stroke: the SPIDER-AF registry (Stroke Prevention by Increasing DEtection Rates of Atrial Fibrillation)

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Abstract

Background

The use of implantable loop recorder (ILR) to detect atrial fibrillation (AF) in patients with a history of cryptogenic stroke (CS) has seldom been investigated in “real-world” settings.

Objective

This study aimed to present the results of the Stroke Prevention by Increasing DEtection Rates of Atrial Fibrillation (SPIDER-AF) registry.

Method

SPIDER is a multicentric, observational registry, including 35 facilities all over Germany. It enrolled outpatients without AF history and with CS before ILR implantation.

Results

We included 500 patients (mean age 63.1 ± 12.7 years), 304 (60.8%) were males, with previous stroke (72.6%) and TIA (27.4%). After inclusion, all were followed for at least 12 months. AF was detected in 133 (26.8%), 25.3% of patients with previous stroke and 29.9% with TIA (p = 0.30). AF was detected after a median of 121.5 days (IQR 40.5–223.0). AF was primarily paroxysmal (95.7% after stroke, 100% after TIA). In 19.5% (n = 26) anticoagulation was not administered after AF detection. Mean CHA2DS2-VASc score (OR 1.22; CI 1.01–1.49; p = 0.037) and age > 70 years (OR 0.41; CI 0.19–0.88; p = 0.0020) correlated with AF. Repeat cerebrovascular events at follow-up (28; 5.6%) correlated with AF (OR = 2.17; CI 1.00–4.72; p = 0.049). AF (p = 0.91) and recurrent events (p = 0.43) occurred similarly in females and males.

Conclusions

In the context of cryptogenic strokes ILRs are a valuable tool for early detection of AF. In a real-world scenario, the anticoagulation therapy remains inadequate despite diagnosed AF in a relevant subset of patients requiring optimization of patient management.

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Data availability

Data are available and can be provided upon written request to the Service GmbH.

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Acknowledgements

The authors thank Peter Klein, mathematician at d.s.h. statistical services GmbH, Rohrbach, Germany, for the statistical input. Project management was the responsibility of Susanne Oldenburg and Simon Glück, BNK Service GmbH, Munich, Germany.

Author information

Authors and Affiliations

  1. Praxis für Kardiologie und Angiologie, Dessau, Germany

    Karin Rybak

  2. Cardiovascular Clinical Research Unit and Department of Cardiology, Vivantes Klinikum Urban, Berlin, Germany

    Giuseppe D´Ancona

  3. BNK-Service GmbH, Brabanter Str. 4, 80805, Munich, Germany

    Simon Glück

  4. Herzklinik Ulm, Magirusstr. 49, 89077, Ulm, Germany

    Winfried Haerer

  5. KARDIOLOGIE 360°, Dienerstr. 12, 80331, Munich, Germany

    Franz Goss

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Correspondence to Karin Rybak.

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Conflict of interest

Medtronic and Bayer Vital GmbH have sponsored the study. KR, SG, WH, and FG have received honorary fees for conducting the study. There are no further conflicts of interest to declare.

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Rybak, K., D´Ancona, G., Glück, S. et al. Detection of atrial fibrillation using an implantable loop recorder in patients with previous cryptogenic stroke: the SPIDER-AF registry (Stroke Prevention by Increasing DEtection Rates of Atrial Fibrillation). Clin Res Cardiol 112, 1848–1859 (2023). https://doi.org/10.1007/s00392-023-02283-4

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