Detection of Paroxysmal Atrial Fibrillation by 30-Day Event Monitoring in Cryptogenic Ischemic Stroke: The Stroke and Monitoring for PAF in Real Time (SMART) Registry
Abstract
Background and Purpose—: Patients with cryptogenic ischemic stroke may have undetected paroxysmal atrial fibrillation (PAF). We established the Stroke and Monitoring for PAF in Real Time (SMART) Registry to determine the yield of 30-day outpatient PAF monitoring in cryptogenic ischemic stroke. Methods—: The SMART Registry was a 3-year, prospective multicenter registry of 239 patients with cryptogenic ischemic stroke undergoing 30-day outpatient autotriggered PAF detection in Kaiser Permanente Northern California. Results—: In intention-to-monitor analysis, PAF was detected in 29 of 239 patients (12.1%; 95% CI, 8.6%–16.9%). After retrospective chart review was performed, a new diagnosis of PAF was confirmed in 26 of 236 patients (11.0%; 95% CI, 7.6%–15.7%). The majority of detected PAF events were asymptomatic; only 6 of 98 recorded PAF events (6.1%) were patient-triggered or associated with symptoms. Conclusions—: -Approximately 1 in every 9 patients with cryptogenic ischemic stroke was found to have new PAF within 30 days. Routine monitoring in this population should be strongly considered.
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In a registry of 239 patients who wore 30-day loop recorders after discharge for cryptogenic ischemic stroke, 24% of all detected cases of occult atrial fibrillation were found in the final 10 days of 30-day monitoring.
“in a registry of 239 patients who wore 30-day loop recorders after discharge for cryptogenic ischemic stroke, researchers found that 24 % of all detected cases of occult atrial fibrillation were found in the final 10 days of 30-day monitoring (i.e., between days 20 and 30) [14].”
From Incidence and timing of potentially high-risk arrhythmias detected through long term continuous ambulatory electrocardiographic monitoring (2016) · cites this paper as [14]
Recent evidence has demonstrated that longer monitoring may be useful to detect arrhythmias in high-risk patient populations, such as those with a recent history of cryptogenic ischemic stroke.
“recent evidence has demonstrated that longer monitoring may be useful to detect arrhythmias in high-risk patient populations, such as those with a recent history of cryptogenic ischemic stroke [8, 14]”
From Incidence and timing of potentially high-risk arrhythmias detected through long term continuous ambulatory electrocardiographic monitoring (2016) · cites this paper as [14]
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- Authors
- Flint, A. C., Banki, N. M., Ren, X., Rao, V. A., & Go, A. S.
- Affiliations
- Kaiser Permanente (US)
- Venue
- Stroke
- Published
- 2012-10
- Volume
- 43
- Issue
- 10
- Pages
- 2788-2790
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2141332306
- Cited by
- 187
- References
- 11
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 7 · 2023: 7 · 2022: 9 · 2021: 7 · 2020: 14 · 2019: 10 · 2018: 15 · 2017: 16 · 2016: 19 · 2015: 30 · 2014: 26 · 2013: 18 · 2012: 2
- FWCI
- 15.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- paroxysmal atrial fibrillation, cryptogenic stroke, event monitoring, asymptomatic atrial fibrillation, stroke risk stratification, atrial fibrillation detection
- MeSH terms
- Aged, Aged, 80 and over, Atrial Fibrillation, California, Female, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Registries, Retrospective Studies, Risk Factors, Time Factors, Cohort Studies, Electrocardiography, Ambulatory, Incidence, Monitoring, Ambulatory, Stroke
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