title: Predictors of finding occult atrial fibrillation after cryptogenic stroke.
abstract: OBJECTIVE
  Occult paroxysmal atrial fibrillation (AF) is found in a substantial minority of patients with cryptogenic stroke. Identifying reliable predictors of paroxysmal AF after cryptogenic stroke would allow clinicians to more effectively use outpatient cardiac monitoring and ultimately reduce secondary stroke burden.
  
  
  METHODS
  We analyzed a retrospective cohort of consecutive patients who underwent 28-day mobile cardiac outpatient telemetry after cryptogenic stroke or transient ischemic stroke. Univariate and multivariable analyses were performed to identify clinical, echocardiographic, and radiographic features associated with the detection of paroxysmal AF.
  
  
  RESULTS
  Of 227 patients with cryptogenic stroke (179) or transient ischemic stroke (48), 14% (95% confidence interval, 9%-18%) had AF detected on mobile cardiac outpatient telemetry, 58% of which was ≥30 seconds in duration. Age >60 years (odds ratio, 3.7; 95% confidence interval, 1.3-11) and prior cortical or cerebellar infarction seen on neuroimaging (odds ratio, 3.0; 95% confidence interval, 1.2-7.6) were independent predictors of AF. AF was detected in 33% of patients with both factors, but only 4% of patients with neither. No other clinical features (including demographics, CHA2DS2-VASc [combined stroke risk score: congestive heart failure, hypertension, age, diabetes, prior stroke/transient ischemic attack, vascular disease, sex] score, or stroke symptoms), echocardiographic findings (including left atrial size or ejection fraction), or radiographic characteristics of the acute infarction (including location, topology, or number) were associated with AF detection.
  
  
  CONCLUSIONS
  Mobile cardiac outpatient telemetry detects AF in a substantial proportion of cryptogenic stroke patients. Age >60 years and radiographic evidence of prior cortical or cerebellar infarction are robust indicators of occult AF. Patients with neither had a low prevalence of AF.
authors: From the Department of Neurology (C.G.F., E.I., J.J., E.F., B.C., S.R.M., M.T.M., J.S., S.E.K.) and Division of Cardiology, Department of Medicine (A.P., M.D.H.), University of Pennsylvania, Philadelphia.
authors: Christopher G
authors: CG
authors: Favilla
authors: From the Department of Neurology (C.G.F., E.I., J.J., E.F., B.C., S.R.M., M.T.M., J.S., S.E.K.) and Division of Cardiology, Department of Medicine (A.P., M.D.H.), University of Pennsylvania, Philadelphia.
authors: Erin
authors: E
authors: Ingala
authors: From the Department of Neurology (C.G.F., E.I., J.J., E.F., B.C., S.R.M., M.T.M., J.S., S.E.K.) and Division of Cardiology, Department of Medicine (A.P., M.D.H.), University of Pennsylvania, Philadelphia.
authors: Jenny
authors: J
authors: Jara
authors: From the Department of Neurology (C.G.F., E.I., J.J., E.F., B.C., S.R.M., M.T.M., J.S., S.E.K.) and Division of Cardiology, Department of Medicine (A.P., M.D.H.), University of Pennsylvania, Philadelphia.
authors: Emily
authors: E
authors: Fessler
authors: From the Department of Neurology (C.G.F., E.I., J.J., E.F., B.C., S.R.M., M.T.M., J.S., S.E.K.) and Division of Cardiology, Department of Medicine (A.P., M.D.H.), University of Pennsylvania, Philadelphia.
authors: Brett
authors: B
authors: Cucchiara
authors: From the Department of Neurology (C.G.F., E.I., J.J., E.F., B.C., S.R.M., M.T.M., J.S., S.E.K.) and Division of Cardiology, Department of Medicine (A.P., M.D.H.), University of Pennsylvania, Philadelphia.
authors: Steven R
authors: SR
authors: Messé
authors: From the Department of Neurology (C.G.F., E.I., J.J., E.F., B.C., S.R.M., M.T.M., J.S., S.E.K.) and Division of Cardiology, Department of Medicine (A.P., M.D.H.), University of Pennsylvania, Philadelphia.
authors: Michael T
authors: MT
authors: Mullen
authors: From the Department of Neurology (C.G.F., E.I., J.J., E.F., B.C., S.R.M., M.T.M., J.S., S.E.K.) and Division of Cardiology, Department of Medicine (A.P., M.D.H.), University of Pennsylvania, Philadelphia.
authors: Allyson
authors: A
authors: Prasad
authors: From the Department of Neurology (C.G.F., E.I., J.J., E.F., B.C., S.R.M., M.T.M., J.S., S.E.K.) and Division of Cardiology, Department of Medicine (A.P., M.D.H.), University of Pennsylvania, Philadelphia.
authors: James
authors: J
authors: Siegler
authors: From the Department of Neurology (C.G.F., E.I., J.J., E.F., B.C., S.R.M., M.T.M., J.S., S.E.K.) and Division of Cardiology, Department of Medicine (A.P., M.D.H.), University of Pennsylvania, Philadelphia.
authors: Mathew D
authors: MD
authors: Hutchinson
authors: From the Department of Neurology (C.G.F., E.I., J.J., E.F., B.C., S.R.M., M.T.M., J.S., S.E.K.) and Division of Cardiology, Department of Medicine (A.P., M.D.H.), University of Pennsylvania, Philadelphia. scott.kasner@uphs.upenn.edu.
authors: Scott E
authors: SE
authors: Kasner
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D002544:Cerebral Infarction / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology
keywords: atrial fibrillation; stroke