title: Paroxysmal atrial fibrillation occurs often in cryptogenic ischaemic stroke. Final results from the SURPRISE study.
abstract: OBJECTIVE
  Atrial fibrillation (AF) increases the risk of stroke fourfold and is associated with a poor clinical outcome. Despite work-up in compliance with guidelines, up to one-third of patients have cryptogenic stroke (CS). The prevalence of asymptomatic paroxysmal atrial fibrillation (PAF) in CS remains unknown. The SURPRISE project aimed at determining this rate using long-term cardiac monitoring.
  
  
  METHODS
  Patients with CS after protocolled work-up including electrocardiography (ECG) and telemetry were included after informed consent. An implantable loop recorder (ILR) was implanted subcutaneously. PAF was defined by events of atrial arrhythmia >2 min with a correlating one-lead ECG confirming the diagnosis.
  
  
  RESULTS
  Eighty-five patients were monitored for a mean of 569 days (SD ±310). PAF was documented in 18 patients (20.7%) during the study period and detected by ILR in 14 patients (16.1%). In three patients PAF was detected by other methods before or after monitoring and was undiscovered due to device sensitivity in one case. The first event of PAF was documented at a mean of 109 days (SD ±48) after stroke onset. PAF was asymptomatic in all cases and occurred in episodes lasting predominantly between 1 and 4 h. Four recurrent strokes were observed, three in patients with PAF; all three patients were on oral anticoagulation (OAC).
  
  
  CONCLUSIONS
  One in five patients with CS had PAF, which occurred at low burden and long after stroke. Future studies should determine the role of implantable cardiac monitors after stroke and determine the potential therapeutic benefit of OAC treatment of patients with PAF.
authors.affiliation: Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospitals, Copenhagen, Denmark.
authors.forename: L M
authors.initials: LM
authors.lastname: Christensen
authors.forename: D W
authors.initials: DW
authors.lastname: Krieger
authors.forename: S
authors.initials: S
authors.lastname: Højberg
authors.forename: O D
authors.initials: OD
authors.lastname: Pedersen
authors.forename: F M
authors.initials: FM
authors.lastname: Karlsen
authors.forename: M D
authors.initials: MD
authors.lastname: Jacobsen
authors.forename: R
authors.initials: R
authors.lastname: Worck
authors.forename: H
authors.initials: H
authors.lastname: Nielsen
authors.forename: K
authors.initials: K
authors.lastname: Aegidius
authors.forename: L L
authors.initials: LL
authors.lastname: Jeppesen
authors.forename: S
authors.initials: S
authors.lastname: Rosenbaum
authors.forename: J
authors.initials: J
authors.lastname: Marstrand
authors.forename: H
authors.initials: H
authors.lastname: Christensen
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000503:physiopathology; D002545:Brain Ischemia / Q000150:complications* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000150:complications* / Q000503:physiopathology
keywords: atrial fibrillation; cardiology; cryptogenic stroke; implantable loop recorder; long-term cardiac monitoring; neurology; paroxysmal atrial fibrillation