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Multiparametric identification of subclinical atrial fibrillation after an embolic stroke of undetermined source

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Abstract

Background

Subclinical atrial fibrillation (SCAF) may represent a cause of embolic stroke of undetermined source (ESUS) and its detection has important implications for secondary prevention with anticoagulation. Indications to implantable cardiac monitors (ICM) include SCAF detection. The aims of this study were to (1) evaluate the frequency of ICM-detected SCAF; (2) determine predictors of SCAF; and (3) identify patients who would benefit most from ICM implantation.

Methods

Between February 2017 and November 2020, all consecutive patients referred for ICM implantation after a diagnosis of ESUS and without previous history of atrial fibrillation or atrial flutter were included in this study. SCAF was diagnosed if the ICM electrogram demonstrated an episode of irregularly irregular rhythm without distinct P waves lasting > 2 min.

Results

We enrolled 109 patients (age 66, SD = 13 years; 36% females). During a median follow-up of 19.2 (IQR 11.0–27.5) months, SCAF episodes were detected in 36 (33%) patients. Only abnormal P wave terminal force in lead V1, left atrial end-systolic indexed volume > 34 ml/m2, and BMI > 25 kg/m2 were independently associated with an increased risk of SCAF (HR 2.44, 95% CI 1.14–5.21, p = 0.021; HR 2.39, 95% CI 1.11–5.13, p = 0.026; and HR 2.64, 95% CI 1.06–6.49, p = 0.036 respectively). The ROC curve showed that the presence of all three parameters had the best accuracy (74%) to predict SCAF detection (sensitivity 39%, specificity 91%).

Conclusion

A multiparametric evaluation has the best accuracy to predict SCAF in ESUS patients and may help identifying those who would benefit most from ICM.

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Authors and Affiliations

  1. Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Forcellini, 209/d, Padua, Italy

    Alvise Del Monte, Francesco Rivezzi, Enrico Giacomin, Federico Migliore, Alessandro Zorzi & Emanuele Bertaglia

  2. Department of Cardiology, Santa Maria del Carmine Hospital, Rovereto, Italy

    Francesco Peruzza, Maurizio Del Greco & Massimiliano Maines

  3. Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padua, Italy

    Federica Viaro, Alessio Pieroni & Claudio Baracchini

  4. Department of Neurology, Santa Maria del Carmine Hospital, Rovereto, Italy

    Andrea La Licata

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  1. Alvise Del Monte
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Correspondence to Emanuele Bertaglia.

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Del Monte, A., Rivezzi, F., Giacomin, E. et al. Multiparametric identification of subclinical atrial fibrillation after an embolic stroke of undetermined source. Neurol Sci 44, 979–988 (2023). https://doi.org/10.1007/s10072-022-06501-1

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