Cryptogenic ischemic stroke and prevalence of asymptomatic atrial fibrillation: a prospective study.
BACKGROUND
Atrial fibrillation is responsible for up to one-third of ischemic strokes, and is also associated with silent cerebral infarctions and transient ischemic attacks (TIAs). The self-terminating and often asymptomatic nature of paroxysmal atrial fibrillation (PAF) may lead to its underdiagnosis. A continuous and long-term heart rhythm monitoring can be useful in unmasking PAF episodes.


OBJECTIVE
Prevalence of asymptomatic PAF in patients suffering a cryptogenic stroke, at risk for atrial fibrillation but without any history of arrhythmia or palpitations, using a continuous electrocardiographic monitoring.


METHODS
One hundred and forty-two consecutive patients were admitted to the Stroke Unit of 'Città della Salute e della Scienza' Hospital of Turin between June 2010 and March 2013 and discharged with the diagnosis of ischemic cryptogenic stroke. Sixty fulfilled predefined inclusion criteria. Follow-up was carried on and completed for the 54 patients who consented to implantable loop recorder (ILR) implantation. After ILR implantation, trans-telephonic data were collected monthly.


RESULTS
Atrial fibrillation episodes lasting more than 5 min were recorded in 25 patients (46%), median detection time was 5.4 months (range 1-18) and median duration of atrial fibrillation episodes was 20 h (range 7 min-8 days) with 19 patients (76%) remaining asymptomatic and the others experiencing weakness and dyspnoea but not palpitations.


CONCLUSIONS
Long-term heart rhythm monitoring is successful in unmasking silent atrial fibrillation in 46% of patients suffering a cryptogenic stroke with concomitant atrial fibrillation risk factors, but without history of arrhythmia or palpitations.
aDivision of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital and Department of Medical Sciences bStroke Unit, 'Città della Salute e della Scienza' Hospital and University of Turin, Turin, Italy.
Marcella
M
Jorfida
Marina
M
Antolini
Enrico
E
Cerrato
Maria Giovanna
MG
Caprioli
Davide
D
Castagno
Paolo
P
Garrone
Carlo
C
Budano
Paolo
P
Cerrato
Fiorenzo
F
Gaita
D000368:Aged; D058070:Asymptomatic Diseases / Q000453:epidemiology*; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging* / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000150:complications*; D013617:Tachycardia, Supraventricular / Q000175:diagnosis*