title: Predictors for atrial fibrillation detection after cryptogenic stroke: Results from CRYSTAL AF.
abstract: OBJECTIVE
  We assessed predictors of atrial fibrillation (AF) in cryptogenic stroke (CS) or transient ischemic attack (TIA) patients who received an insertable cardiac monitor (ICM).
  
  
  METHODS
  We studied patients with CS/TIA who were randomized to ICM within the CRYSTAL AF study. We assessed whether age, sex, race, body mass index, type and severity of index ischemic event, CHADS2 score, PR interval, and presence of diabetes, hypertension, congestive heart failure, or patent foramen ovale and premature atrial contractions predicted AF development within the initial 12 and 36 months of follow-up using Cox proportional hazards models.
  
  
  RESULTS
  Among 221 patients randomized to ICM (age 61.6 ± 11.4 years, 64% male), AF episodes were detected in 29 patients within 12 months and 42 patients at 36 months. Significant univariate predictors of AF at 12 months included age (hazard ratio [HR] per decade 2.0 [95% confidence interval 1.4-2.8], p = 0.002), CHADS2 score (HR 1.9 per one point [1.3-2.8], p = 0.008), PR interval (HR 1.3 per 10 milliseconds [1.2-1.4], p < 0.0001), premature atrial contractions (HR 3.9 for >123 vs 0 [1.3-12.0], p = 0.009 across quartiles), and diabetes (HR 2.3 [1.0-5.2], p < 0.05). In multivariate analysis, age (HR per decade 1.9 [1.3-2.8], p = 0.0009) and PR interval (HR 1.3 [1.2-1.4], p < 0.0001) remained significant and together yielded an area under the receiver operating characteristic curve of 0.78 (0.70-0.85). The same predictors were found at 36 months.
  
  
  CONCLUSIONS
  Increasing age and a prolonged PR interval at enrollment were independently associated with an increased AF incidence in CS patients. However, they offered only moderate predictive ability in determining which CS patients had AF detected by the ICM.
authors.affiliation: From the Florey Institute of Neuroscience and Mental Health and Austin Health Department of Neurology (V.N.T.), Heidelberg, Australia; Hospital Klinikum Coburg (J.B.), Teaching Hospital of the University of Würzburg, Coburg, Germany; Population Health Research Institute (C.A.M.), McMaster University, Hamilton, Canada; Northwestern University Feinberg School of Medicine (R.S.P.), Chicago, IL; Institute of Cardiology (T.S.), Catholic University of the Sacred Heart, Rome, Italy; Davee Department of Neurology (R.A.B.), Northwestern University, Chicago, IL; Department of Neurology (H.-C.D.), University Hospital Essen University Duisburg-Essen, Germany; Institute of Neurology (V.D.L.), University Campus Bio-Medico of Rome, Rome, Italy; University of Kansas Medical Center (M.M.R.), Kansas City; Medtronic (L.H.), Maastricht, Netherlands; Medtronic (T.B.R., P.D.Z.), Mounds View, Minneapolis, MN; and Baylor University Medical Center (M.D.A.), Dallas, TX. vincent.thijs@florey.edu.au.
authors.forename: Vincent N
authors.initials: VN
authors.lastname: Thijs
authors.affiliation: From the Florey Institute of Neuroscience and Mental Health and Austin Health Department of Neurology (V.N.T.), Heidelberg, Australia; Hospital Klinikum Coburg (J.B.), Teaching Hospital of the University of Würzburg, Coburg, Germany; Population Health Research Institute (C.A.M.), McMaster University, Hamilton, Canada; Northwestern University Feinberg School of Medicine (R.S.P.), Chicago, IL; Institute of Cardiology (T.S.), Catholic University of the Sacred Heart, Rome, Italy; Davee Department of Neurology (R.A.B.), Northwestern University, Chicago, IL; Department of Neurology (H.-C.D.), University Hospital Essen University Duisburg-Essen, Germany; Institute of Neurology (V.D.L.), University Campus Bio-Medico of Rome, Rome, Italy; University of Kansas Medical Center (M.M.R.), Kansas City; Medtronic (L.H.), Maastricht, Netherlands; Medtronic (T.B.R., P.D.Z.), Mounds View, Minneapolis, MN; and Baylor University Medical Center (M.D.A.), Dallas, TX.
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
authors.affiliation: From the Florey Institute of Neuroscience and Mental Health and Austin Health Department of Neurology (V.N.T.), Heidelberg, Australia; Hospital Klinikum Coburg (J.B.), Teaching Hospital of the University of Würzburg, Coburg, Germany; Population Health Research Institute (C.A.M.), McMaster University, Hamilton, Canada; Northwestern University Feinberg School of Medicine (R.S.P.), Chicago, IL; Institute of Cardiology (T.S.), Catholic University of the Sacred Heart, Rome, Italy; Davee Department of Neurology (R.A.B.), Northwestern University, Chicago, IL; Department of Neurology (H.-C.D.), University Hospital Essen University Duisburg-Essen, Germany; Institute of Neurology (V.D.L.), University Campus Bio-Medico of Rome, Rome, Italy; University of Kansas Medical Center (M.M.R.), Kansas City; Medtronic (L.H.), Maastricht, Netherlands; Medtronic (T.B.R., P.D.Z.), Mounds View, Minneapolis, MN; and Baylor University Medical Center (M.D.A.), Dallas, TX.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Morillo
authors.affiliation: From the Florey Institute of Neuroscience and Mental Health and Austin Health Department of Neurology (V.N.T.), Heidelberg, Australia; Hospital Klinikum Coburg (J.B.), Teaching Hospital of the University of Würzburg, Coburg, Germany; Population Health Research Institute (C.A.M.), McMaster University, Hamilton, Canada; Northwestern University Feinberg School of Medicine (R.S.P.), Chicago, IL; Institute of Cardiology (T.S.), Catholic University of the Sacred Heart, Rome, Italy; Davee Department of Neurology (R.A.B.), Northwestern University, Chicago, IL; Department of Neurology (H.-C.D.), University Hospital Essen University Duisburg-Essen, Germany; Institute of Neurology (V.D.L.), University Campus Bio-Medico of Rome, Rome, Italy; University of Kansas Medical Center (M.M.R.), Kansas City; Medtronic (L.H.), Maastricht, Netherlands; Medtronic (T.B.R., P.D.Z.), Mounds View, Minneapolis, MN; and Baylor University Medical Center (M.D.A.), Dallas, TX.
authors.forename: Rod S
authors.initials: RS
authors.lastname: Passman
authors.affiliation: From the Florey Institute of Neuroscience and Mental Health and Austin Health Department of Neurology (V.N.T.), Heidelberg, Australia; Hospital Klinikum Coburg (J.B.), Teaching Hospital of the University of Würzburg, Coburg, Germany; Population Health Research Institute (C.A.M.), McMaster University, Hamilton, Canada; Northwestern University Feinberg School of Medicine (R.S.P.), Chicago, IL; Institute of Cardiology (T.S.), Catholic University of the Sacred Heart, Rome, Italy; Davee Department of Neurology (R.A.B.), Northwestern University, Chicago, IL; Department of Neurology (H.-C.D.), University Hospital Essen University Duisburg-Essen, Germany; Institute of Neurology (V.D.L.), University Campus Bio-Medico of Rome, Rome, Italy; University of Kansas Medical Center (M.M.R.), Kansas City; Medtronic (L.H.), Maastricht, Netherlands; Medtronic (T.B.R., P.D.Z.), Mounds View, Minneapolis, MN; and Baylor University Medical Center (M.D.A.), Dallas, TX.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Sanna
authors.affiliation: From the Florey Institute of Neuroscience and Mental Health and Austin Health Department of Neurology (V.N.T.), Heidelberg, Australia; Hospital Klinikum Coburg (J.B.), Teaching Hospital of the University of Würzburg, Coburg, Germany; Population Health Research Institute (C.A.M.), McMaster University, Hamilton, Canada; Northwestern University Feinberg School of Medicine (R.S.P.), Chicago, IL; Institute of Cardiology (T.S.), Catholic University of the Sacred Heart, Rome, Italy; Davee Department of Neurology (R.A.B.), Northwestern University, Chicago, IL; Department of Neurology (H.-C.D.), University Hospital Essen University Duisburg-Essen, Germany; Institute of Neurology (V.D.L.), University Campus Bio-Medico of Rome, Rome, Italy; University of Kansas Medical Center (M.M.R.), Kansas City; Medtronic (L.H.), Maastricht, Netherlands; Medtronic (T.B.R., P.D.Z.), Mounds View, Minneapolis, MN; and Baylor University Medical Center (M.D.A.), Dallas, TX.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Bernstein
authors.affiliation: From the Florey Institute of Neuroscience and Mental Health and Austin Health Department of Neurology (V.N.T.), Heidelberg, Australia; Hospital Klinikum Coburg (J.B.), Teaching Hospital of the University of Würzburg, Coburg, Germany; Population Health Research Institute (C.A.M.), McMaster University, Hamilton, Canada; Northwestern University Feinberg School of Medicine (R.S.P.), Chicago, IL; Institute of Cardiology (T.S.), Catholic University of the Sacred Heart, Rome, Italy; Davee Department of Neurology (R.A.B.), Northwestern University, Chicago, IL; Department of Neurology (H.-C.D.), University Hospital Essen University Duisburg-Essen, Germany; Institute of Neurology (V.D.L.), University Campus Bio-Medico of Rome, Rome, Italy; University of Kansas Medical Center (M.M.R.), Kansas City; Medtronic (L.H.), Maastricht, Netherlands; Medtronic (T.B.R., P.D.Z.), Mounds View, Minneapolis, MN; and Baylor University Medical Center (M.D.A.), Dallas, TX.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
authors.affiliation: From the Florey Institute of Neuroscience and Mental Health and Austin Health Department of Neurology (V.N.T.), Heidelberg, Australia; Hospital Klinikum Coburg (J.B.), Teaching Hospital of the University of Würzburg, Coburg, Germany; Population Health Research Institute (C.A.M.), McMaster University, Hamilton, Canada; Northwestern University Feinberg School of Medicine (R.S.P.), Chicago, IL; Institute of Cardiology (T.S.), Catholic University of the Sacred Heart, Rome, Italy; Davee Department of Neurology (R.A.B.), Northwestern University, Chicago, IL; Department of Neurology (H.-C.D.), University Hospital Essen University Duisburg-Essen, Germany; Institute of Neurology (V.D.L.), University Campus Bio-Medico of Rome, Rome, Italy; University of Kansas Medical Center (M.M.R.), Kansas City; Medtronic (L.H.), Maastricht, Netherlands; Medtronic (T.B.R., P.D.Z.), Mounds View, Minneapolis, MN; and Baylor University Medical Center (M.D.A.), Dallas, TX.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Di Lazzaro
authors.affiliation: From the Florey Institute of Neuroscience and Mental Health and Austin Health Department of Neurology (V.N.T.), Heidelberg, Australia; Hospital Klinikum Coburg (J.B.), Teaching Hospital of the University of Würzburg, Coburg, Germany; Population Health Research Institute (C.A.M.), McMaster University, Hamilton, Canada; Northwestern University Feinberg School of Medicine (R.S.P.), Chicago, IL; Institute of Cardiology (T.S.), Catholic University of the Sacred Heart, Rome, Italy; Davee Department of Neurology (R.A.B.), Northwestern University, Chicago, IL; Department of Neurology (H.-C.D.), University Hospital Essen University Duisburg-Essen, Germany; Institute of Neurology (V.D.L.), University Campus Bio-Medico of Rome, Rome, Italy; University of Kansas Medical Center (M.M.R.), Kansas City; Medtronic (L.H.), Maastricht, Netherlands; Medtronic (T.B.R., P.D.Z.), Mounds View, Minneapolis, MN; and Baylor University Medical Center (M.D.A.), Dallas, TX.
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Rymer
authors.affiliation: From the Florey Institute of Neuroscience and Mental Health and Austin Health Department of Neurology (V.N.T.), Heidelberg, Australia; Hospital Klinikum Coburg (J.B.), Teaching Hospital of the University of Würzburg, Coburg, Germany; Population Health Research Institute (C.A.M.), McMaster University, Hamilton, Canada; Northwestern University Feinberg School of Medicine (R.S.P.), Chicago, IL; Institute of Cardiology (T.S.), Catholic University of the Sacred Heart, Rome, Italy; Davee Department of Neurology (R.A.B.), Northwestern University, Chicago, IL; Department of Neurology (H.-C.D.), University Hospital Essen University Duisburg-Essen, Germany; Institute of Neurology (V.D.L.), University Campus Bio-Medico of Rome, Rome, Italy; University of Kansas Medical Center (M.M.R.), Kansas City; Medtronic (L.H.), Maastricht, Netherlands; Medtronic (T.B.R., P.D.Z.), Mounds View, Minneapolis, MN; and Baylor University Medical Center (M.D.A.), Dallas, TX.
authors.forename: Laurence
authors.initials: L
authors.lastname: Hogge
authors.affiliation: From the Florey Institute of Neuroscience and Mental Health and Austin Health Department of Neurology (V.N.T.), Heidelberg, Australia; Hospital Klinikum Coburg (J.B.), Teaching Hospital of the University of Würzburg, Coburg, Germany; Population Health Research Institute (C.A.M.), McMaster University, Hamilton, Canada; Northwestern University Feinberg School of Medicine (R.S.P.), Chicago, IL; Institute of Cardiology (T.S.), Catholic University of the Sacred Heart, Rome, Italy; Davee Department of Neurology (R.A.B.), Northwestern University, Chicago, IL; Department of Neurology (H.-C.D.), University Hospital Essen University Duisburg-Essen, Germany; Institute of Neurology (V.D.L.), University Campus Bio-Medico of Rome, Rome, Italy; University of Kansas Medical Center (M.M.R.), Kansas City; Medtronic (L.H.), Maastricht, Netherlands; Medtronic (T.B.R., P.D.Z.), Mounds View, Minneapolis, MN; and Baylor University Medical Center (M.D.A.), Dallas, TX.
authors.forename: Tyson B
authors.initials: TB
authors.lastname: Rogers
authors.affiliation: From the Florey Institute of Neuroscience and Mental Health and Austin Health Department of Neurology (V.N.T.), Heidelberg, Australia; Hospital Klinikum Coburg (J.B.), Teaching Hospital of the University of Würzburg, Coburg, Germany; Population Health Research Institute (C.A.M.), McMaster University, Hamilton, Canada; Northwestern University Feinberg School of Medicine (R.S.P.), Chicago, IL; Institute of Cardiology (T.S.), Catholic University of the Sacred Heart, Rome, Italy; Davee Department of Neurology (R.A.B.), Northwestern University, Chicago, IL; Department of Neurology (H.-C.D.), University Hospital Essen University Duisburg-Essen, Germany; Institute of Neurology (V.D.L.), University Campus Bio-Medico of Rome, Rome, Italy; University of Kansas Medical Center (M.M.R.), Kansas City; Medtronic (L.H.), Maastricht, Netherlands; Medtronic (T.B.R., P.D.Z.), Mounds View, Minneapolis, MN; and Baylor University Medical Center (M.D.A.), Dallas, TX.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Ziegler
authors.affiliation: From the Florey Institute of Neuroscience and Mental Health and Austin Health Department of Neurology (V.N.T.), Heidelberg, Australia; Hospital Klinikum Coburg (J.B.), Teaching Hospital of the University of Würzburg, Coburg, Germany; Population Health Research Institute (C.A.M.), McMaster University, Hamilton, Canada; Northwestern University Feinberg School of Medicine (R.S.P.), Chicago, IL; Institute of Cardiology (T.S.), Catholic University of the Sacred Heart, Rome, Italy; Davee Department of Neurology (R.A.B.), Northwestern University, Chicago, IL; Department of Neurology (H.-C.D.), University Hospital Essen University Duisburg-Essen, Germany; Institute of Neurology (V.D.L.), University Campus Bio-Medico of Rome, Rome, Italy; University of Kansas Medical Center (M.M.R.), Kansas City; Medtronic (L.H.), Maastricht, Netherlands; Medtronic (T.B.R., P.D.Z.), Mounds View, Minneapolis, MN; and Baylor University Medical Center (M.D.A.), Dallas, TX.
authors.forename: Manish D
authors.initials: MD
authors.lastname: Assar
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology; D015897:Comorbidity; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000453:epidemiology