title: Unexpected low prevalence of atrial fibrillation in cryptogenic ischemic stroke: a prospective study.
abstract: OBJECTIVE
  Ischemic stroke is a frequent pathology with high rate of recurrence and significant morbidity and mortality. There are several causes of stroke, affecting prognosis, outcomes, and management, but in many cases, the etiology remains undetermined. We hypothesized that atrial fibrillation was involved in this pathology but underdiagnosed by standard methods. The aim of the study was to determine the incidence of atrial fibrillation in cryptogenic ischemic stroke by using continuous monitoring of the heart rate over several months. The secondary objective was to test the value of atrial vulnerability assessment in predicting spontaneous atrial fibrillation.
  
  
  RESULTS
  We prospectively enrolled 24 patients under 75 years of age, 15 men and 9 women of mean age 49 years, who within the last 4 months had experienced cryptogenic stroke diagnosed by clinical presentation and brain imaging and presumed to be of cardioembolic mechanism. All causes of stroke were excluded by normal 12-lead ECG, 24-h Holter monitoring, echocardiography, cervical Doppler, hematological, and inflammatory tests. All patients underwent electrophysiological study. Of the patients, 37.5% had latent atrial vulnerability, and 33.3% had inducible sustained arrhythmia. Patients were secondarily implanted with an implantable loop recorder to look for spontaneous atrial fibrillation over a mean follow-up interval of 14.5 months. No sustained arrhythmia was found. Only one patient had non-significant episodes of atrial fibrillation.
  
  
  CONCLUSIONS
  In this study, symptomatic atrial fibrillation or AF with fast ventricular rate has not been demonstrated by the implantable loop recorder in patients under 75 years with unexplained cerebral ischemia. The use of this device should not be generalized in the systematic evaluation of these patients. In addition, this study attests that the assessment of atrial vulnerability is poor at predicting spontaneous arrhythmia in such patients.
authors.affiliation: Service de Cardiologie B, pôle Coeur, Thorax, Vaisseaux, hôpital Trousseau, Tours University, CHRU de Tours, 37044, Tours Cedex 9, France.
authors.forename: Fanny
authors.initials: F
authors.lastname: Dion
authors.forename: Denis
authors.initials: D
authors.lastname: Saudeau
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bonnaud
authors.forename: Patrick
authors.initials: P
authors.lastname: Friocourt
authors.forename: Armel
authors.initials: A
authors.lastname: Bonneau
authors.forename: Philippe
authors.initials: P
authors.lastname: Poret
authors.forename: Bruno
authors.initials: B
authors.lastname: Giraudeau
authors.forename: Sandra
authors.initials: S
authors.lastname: Régina
authors.forename: Laurent
authors.initials: L
authors.lastname: Fauchier
authors.forename: Dominique
authors.initials: D
authors.lastname: Babuty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000453:epidemiology*; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000453:epidemiology* / Q000209:etiology*; D004452:Echocardiography; D004562:Electrocardiography / Q000379:methods; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018608:Ultrasonography, Doppler
chemical_list: D015415:Biomarkers
references.citation: Circulation. 1999 Jun 15;99(23):3028-35
references.pmid: 10368121
references.citation: Circulation. 1994 Jan;89(1):224-7
references.pmid: 8281651
references.citation: Stroke. 2000 Sep;31(9):2074-9
references.pmid: 10978032
references.citation: JAMA. 2002 Nov 20;288(19):2441-8
references.pmid: 12435257
references.citation: Stroke. 2000 May;31(5):1062-8
references.pmid: 10797166
references.citation: Stroke. 1986 Mar-Apr;17(2):192-5
references.pmid: 2938308
references.citation: Arch Intern Med. 1994 Jul 11;154(13):1449-57
references.pmid: 8018000
references.citation: Pacing Clin Electrophysiol. 1986 Nov;9(6):1121-6
references.pmid: 2432519
references.citation: Arch Mal Coeur Vaiss. 2006 Mar;99(3):221-9
references.pmid: 16618025
references.citation: Pacing Clin Electrophysiol. 2004 May;27(5):657-64
references.pmid: 15125724
references.citation: Acta Neurol Scand. 2008 May;117(5):311-6
references.pmid: 18042269
references.citation: J Interv Card Electrophysiol. 2004 Jun;10(3):211-20
references.pmid: 15133357
references.citation: JAMA. 1994 Mar 16;271(11):840-4
references.pmid: 8114238
references.citation: Circulation. 2001 Jul 3;104(1):46-51
references.pmid: 11435336
references.citation: Can J Neurol Sci. 2000 Feb;27(1):25-31
references.pmid: 10676584
references.citation: Stroke. 1999 Nov;30(11):2502-11
references.pmid: 10548693
references.citation: Stroke. 1994 Feb;25(2):333-7
references.pmid: 8303740
references.citation: Ann Cardiol Angeiol (Paris). 2003 Aug;52(4):220-5
references.pmid: 14603702
references.citation: Arch Mal Coeur Vaiss. 1991 Jul;84(7):949-56
references.pmid: 1929714
references.citation: Stroke. 1995 Mar;26(3):514-21
references.pmid: 7886735
references.citation: Stroke. 2001 Dec 1;32(12):2735-40
references.pmid: 11739965
references.citation: Stroke. 2000 Feb;31(2):398-403
references.pmid: 10657412
references.citation: JAMA. 2001 May 9;285(18):2370-5
references.pmid: 11343485
references.citation: Neurology. 2008 Nov 18;71(21):1696-701
references.pmid: 18815386
references.citation: Stroke. 2007 Nov;38(11):2935-40
references.pmid: 17901394
references.citation: Stroke. 1993 Jan;24(1):26-30
references.pmid: 8418546
references.citation: Stroke. 2005 Jun;36(6):1115-9
references.pmid: 15879330
references.citation: Lancet. 2005 Jun 18-24;365(9477):2098-104
references.pmid: 15964446
references.citation: Pacing Clin Electrophysiol. 2002 Nov;25(11):1587-93
references.pmid: 12494616
references.citation: Stroke. 1988 May;19(5):604-7
references.pmid: 3363593
references.citation: Ann Intern Med. 2003 May 20;138(10):831-8
references.pmid: 12755555
references.citation: JAMA. 2001 Jun 13;285(22):2864-70
references.pmid: 11401607