title: Total atrial conduction time to predict occult atrial fibrillation after cryptogenic stroke.
abstract: BACKGROUND
  Insertable cardiac monitor (ICM) increases the detection rate of occult atrial fibrillation (AF) after cryptogenic stroke. The aim of this study was to evaluate the prognostic significance of total atrial conduction time (TACT) assessed by tissue Doppler imaging (PA-TDI interval) to predict AF presence in patients with cryptogenic stroke.
  
  
  METHODS
  Ninety patients (57.7 ± 12.3 years, 48 % women) after acute cryptogenic stroke and ICM implantation were prospective recruited at four centers for continuous rhythm monitoring. In all patients, TACT was measured by PA-TDI interval via echocardiography. Patients were followed up (331 ± 186 days) for detection of AF (defined by episode lasting ≥30 s).
  
  
  RESULTS
  AF was detected in 16 patients (18 %) during follow-up (331 ± 186 days). The median period to AF detection was 30 days (q1-q3; 16-62 days). Patients who exhibited occult AF were characterized by significantly longer PA-TDI intervals (154.7 ± 12.6 vs. 133.9 ± 9.5 ms, p < 0.0001). The cut-off value of PA-TDI interval at 145 ms demonstrated sensitivity and specificity for AF detection of 93.8 and 90.5 %, respectively. In multivariate analysis, CHA2DS2-VASc score (HR 1.96 per 1 point, p < 0.01) and longer PA-TDI interval (HR 4.05 per 10 ms, p < 0.0001) were independent predictors of occult AF.
  
  
  CONCLUSIONS
  Our data suggest that measurement of TACT could help to predict future AF detection in patients with cryptogenic stroke. The clinical importance of prolonged rhythm monitoring or indication of direct anticoagulation therapy after cryptogenic stroke based on TACT should be further investigated.
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiac Arrhythmia Service, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, 40225, Düsseldorf, Germany. Patrick.Mueller@med.uni-duesseldorf.de.
authors.forename: Patrick
authors.initials: P
authors.lastname: Müller
authors.affiliation: Cardiovascular Center, St. Josef Hospital Bochum, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Ivanov
authors.affiliation: Cardiovascular Center, St. Josef Hospital Bochum, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Kaffer
authors.initials: K
authors.lastname: Kara
authors.affiliation: Department of Cardiology, Katholisches Klinikum Essen, University of Witten/Herdecke, Essen, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Klein-Wiele
authors.affiliation: Division of Electrophysiology, Heart Center Dresden, University of Dresden, Dresden, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Forkmann
authors.affiliation: Division of Electrophysiology, Heart Center Dresden, University of Dresden, Dresden, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Piorkowski
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiac Arrhythmia Service, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, 40225, Düsseldorf, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Blockhaus
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiac Arrhythmia Service, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, 40225, Düsseldorf, Germany.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Dimitroulis
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiac Arrhythmia Service, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, 40225, Düsseldorf, Germany.
authors.forename: Shazia
authors.initials: S
authors.lastname: Afzal
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiac Arrhythmia Service, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, 40225, Düsseldorf, Germany.
authors.forename: Dong-In
authors.initials: DI
authors.lastname: Shin
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiac Arrhythmia Service, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, 40225, Düsseldorf, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.affiliation: Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiac Arrhythmia Service, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, 40225, Düsseldorf, Germany.
authors.forename: Hisaki
authors.initials: H
authors.lastname: Makimoto
authors.affiliation: Cardiovascular Center, St. Josef Hospital Bochum, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Mügge
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016275:Atrial Function; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation; D005260:Female; D005858:Germany; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology*; D013997:Time Factors
keywords: Atrial fibrillation; Cryptogenic stroke; PA-TDI interval