title: Infarct Topography and Detection of Atrial Fibrillation in Cryptogenic Stroke: Results from CRYSTAL AF.
abstract: BACKGROUND
  Insertable cardiac monitors (ICM) have been shown to detect atrial fibrillation (AF) at a higher rate than routine monitoring methods in patients with cryptogenic stroke (CS). However, it is unknown whether there are topographic patterns of brain infarction in patients with CS that are particularly associated with underlying AF. If such patterns exist, these could be used to help decide whether or not CS patients would benefit from long-term monitoring with an ICM.
  
  
  METHODS
  In this retrospective analysis, a neuro-radiologist blinded to clinical details reviewed brain images from 212 patients with CS who were enrolled in the ICM arm of the CRYptogenic STroke And underLying AF (CRYSTAL AF) trial. Kaplan-Meier estimates were used to describe rates of AF detection at 12 months in patients with and without pre-specified imaging characteristics. Hazard ratios (HRs), 95% confidence intervals (CIs), and p values were calculated using Cox regression.
  
  
  RESULTS
  We did not find any pattern of acute brain infarction that was significantly associated with AF detection after CS. However, the presence of chronic brain infarctions (15.8 vs. 7.0%, HR 2.84, 95% CI 1.13-7.15, p = 0.02) or leukoaraiosis (18.2 vs. 7.9%, HR 2.94, 95% CI 1.28-6.71, p < 0.01) was associated with AF detection. There was a borderline significant association of AF detection with the presence of chronic territorial (defined as within the territory of a first or second degree branch of the circle of Willis) infarcts (20.9 vs. 10.0%, HR 2.37, 95% CI 0.98-5.72, p = 0.05).
  
  
  CONCLUSIONS
  We found no evidence for an association between brain infarction pattern and AF detection using an ICM in patients with CS, although patients with coexisting chronic, as well as acute, brain infarcts had a higher rate of AF detection. Acute brain infarction topography does not reliably predict or exclude detection of underlying AF in patients with CS and should not be used to select patients for ICM after cryptogenic stroke.
authors.affiliation: Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Ill., USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Bernstein
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Di Lazzaro
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Rymer
authors.forename: Rod S
authors.initials: RS
authors.lastname: Passman
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Morillo
authors.forename: Tommaso
authors.initials: T
authors.lastname: Sanna
authors.forename: Vincent
authors.initials: V
authors.lastname: Thijs
authors.forename: Tyson
authors.initials: T
authors.lastname: Rogers
authors.forename: Shufeng
authors.initials: S
authors.lastname: Liu
authors.forename: Paul D
authors.initials: PD
authors.lastname: Ziegler
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
mesh_terms: D000208:Acute Disease; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis*; D002908:Chronic Disease; D003952:Diagnostic Imaging / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D006801:Humans; D053208:Kaplan-Meier Estimate; D049292:Leukoaraiosis / Q000175:diagnosis / Q000209:etiology; D008279:Magnetic Resonance Imaging; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed