title: Predictors of Occult Atrial Fibrillation in One Hundred Seventy-One Patients with Cryptogenic Transient Ischemic Attack and Minor Stroke.
abstract: OBJECTIVE
  Recent randomized studies have shown the potential of prolonged cardiac rhythm monitoring to detect silent paroxysmal atrial fibrillation (PAF) in patients with cryptogenic stroke. Our aim was to identify clinical and magnetic resonance imaging (MRI) factors that predict the detection of PAF during long-duration rhythm cardiac Holter (LDRCH) monitoring.
  
  
  METHODS
  A retrospective analysis was performed using data from 171 patients with cryptogenic stroke or transient ischemic attack who underwent LDRCH monitoring (i.e., 21 days) from 2009 to 2013. Clinical, echocardiographic, and imaging predictors of atrial fibrillation (AF) were determined by multivariable analysis.
  
  
  RESULTS
  PAF lasting more than or equal to 30 seconds was diagnosed in 26 of 171 (15%) patients. Median delay to first detected AF episode was 7 (interquartile range: 2-13) days. Four factors were independently predictive of PAF detection on LDRCH: age more than 70 years (odds ratio [OR], 4.6; 95% confidence interval [CI], 1.5-13.8); premature atrial complex on electrocardiogram (OR, 4.6; 95% CI, 1.1-19.6); left ventricular hypertrophy on transthoracic echocardiography (OR, 6.4, 95% CI, 1.6-26.4); and previous white matter lesions on brain MRI (OR, 4.2; 95% CI, 1.2-15.6). Recent brain infarction pattern on diffusion-weighted imaging was not associated with PAF detection on LDRCH.
  
  
  CONCLUSIONS
  LDRCH is a noninvasive and inexpensive test with a high rate of AF detection in patients with cryptogenic stroke or transient ischemic attack. Occult PAF was more commonly diagnosed in older patients with premature atrial complex on the baseline electrocardiogram, left ventricular hypertrophy on echocardiography, and with previous white matter lesions on brain MRI.
authors: Neurology Department and Stroke Center, Mignot Hospital, Le Chesnay, France.
authors: Veronica
authors: V
authors: Sudacevschi
authors: Cardiology Department, Parly 2 Clinic, Le Chesnay, France.
authors: Cathy
authors: C
authors: Bertrand
authors: Neurology Department and Stroke Center, Mignot Hospital, Le Chesnay, France.
authors: Marie L
authors: ML
authors: Chadenat
authors: DRCI (Delegation à la Recherche Clinique), Mignot Hospital, Le Chesnay, France.
authors: Chloé
authors: C
authors: Tarnaud
authors: Neurology Department and Stroke Center, Mignot Hospital, Le Chesnay, France; Versailles Saint-Quentin en Yvelines University, Versailles, France; INSERM LVTS (Laboratory for Vascular Translational Science)-1148, Paris, France. Electronic address: fpico@ch-versailles.fr.
authors: Fernando
authors: F
authors: Pico
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D018880:Atrial Premature Complexes / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D016009:Chi-Square Distribution; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000000981:diagnostic imaging; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology*; D056784:Leukoencephalopathies / Q000150:complications / Q000000981:diagnostic imaging; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology*
keywords: MRI; Stroke; atrial fibrillation; long-duration rhythm cardiac Holter; vascular risk factors