Large Vessel Occlusion is Independently Associated with Atrial Fibrillation Detection

BACKGROUND:

Cover paroxysmal atrial fibrillation (pAF) is the most frequent cause of cardiac embolism. Our goal was to discover parameters associated with early pAF detection with intensive cardiac monitoring.

METHODS:

Crypto-AF was a multicenter prospective study (four Comprehensive Stroke Centers) to detect pAF in non-lacunar cryptogenic stroke continuously monitored within the first 28 days. We assessed: stroke severity, infarct pattern, large vessel occlusion at baseline (LVO), EKG analysis, supraventricular extrasystolia in Holter, left atria volume index (LAVI) and BNP level. The percentage of pAF detection and pAF episodes lasting more than 5 hours were registered.

RESULTS:

Out of 296 patients included 264 patients completed the monitoring period with 23.1% (61/264) of pAF detection. Patients with pAF were older OR 1.04 (95% CI 1.01-1.08); they had more hemorrhagic infarction OR 4.03 (95% CI 1.44-11.22), they were more likely to have LVO OR 4.29 (95% CI 2.31-7.97) (p < 0.0001), they had larger LAVI OR 1.03 (95% CI 1.01-1.1) (p = 0.0002) and higher level of BNP OR 1.01 (95% CI 1.0-1.1). The age and LVO were independently associated with pAF detection, OR 1.06 (1.00; 1.16) and OR 4.58 (2.27; 21.38) respectively. Patients with LVO had higher cumulative incidence of pAF (log rank p <0.001) and more percentage of PAF>5 hours 29.6% (21/71) Vs. 8.3% (12/144) OR 4.62 (95% CI 2.11-10.08), (p<0.001). In mean follow up of 26.82 months (SD 10.15) the stroke recurrence rate was 4.6% (12/260).

CONCLUSIONS:

LVO in cryptogenic stroke emerged as an independent marker of pAF.