Patients With Ischemic Stroke Due to LAD, SVD Have Increased Risk of Atrial Fibrillation Over Time

Patients with ischemic stroke attributed to large-artery atherosclerotic disease (LAD) or small-vessel occlusive disease (SVD) incur a greater risk of atrial fibrillation (AF) over time, and the AF occurrences are not reliably detected using standard monitoring methods, according to a new study published in JAMA Neurology.

“[AF] quintuples the risk of ischemic stroke in patients with other stroke risk factors. Prior ischemic stroke is a potent risk factor, and in common risk-stratification schemes, it increases the predicted risk of future stroke regardless of the putative mechanism of the prior stroke,” the researchers noted. “Use of insertable cardiac monitoring [(ICM)] has been shown to result in a higher rate of detection of AF compared with standard monitoring techniques in patients with cryptogenic stroke and an appearance suggesting embolic stroke of undetermined source and, more recently, with [LAD] or [SVD].”

In the STROKE AF trial, 492 patients were randomized 1:1 to ICM or site-specific usual care. Patients in the population of interest were aged 60 years or older, or aged 50 to 59 years with at least 1 additional stroke risk factor, and all had an index ischemic stroke attributed to LAD or SVD within 10 days prior to ICM insertion. The main outcome of interest was AF detection through study follow-up, which was up to 3 years.

The results showed that the incidence rate of AF at 3 years was 21.7% in the ICM group versus 2.4% in the control group. Researchers concluded that “patients with ischemic stroke attributed to LAD or SVD face an increasing risk of AF over time, and most of the AF occurrences are not reliably detected by standard medical monitoring methods. One year of negative monitoring should not reassure clinicians that stroke patients will not develop AF over the next 2 years.”