Incidence of atrial fibrillation detected by implantable loop recorders in unexplained stroke
Open accessAbstract
OBJECTIVES: The usefulness of the implantable loop recorder (ILR) with improved atrial fibrillation (AF) detection capability (Reveal XT) and the factors associated with AF in the setting of unexplained stroke were investigated. METHODS: A cohort study is reported of 51 patients in whom ILRs were implanted for the investigation of ischemic stroke for which no cause had been found (cryptogenic) following appropriate vascular and cardiac imaging and at least 24 hours of cardiac rhythm monitoring. RESULTS: The patients were aged from 17 to 73 (median 52) years. Of the 30 patients with a shunt investigation, 22 had a patent foramen ovale (73.3%; 95% confidence interval [CI] 56.5%-90.1%). AF was identified in 13 (25.5%; 95% CI 13.1%-37.9%) cases. AF was associated with increasing age (p = 0.018), interatrial conduction block (p = 0.02), left atrial volume (p = 0.025), and the occurrence of atrial premature contractions on preceding external monitoring (p = 0.004). The median (range) of monitoring prior to AF detection was 48 (0-154) days. CONCLUSION: In patients with unexplained stroke, AF was detected by ILR in 25.5%. Predictors of AF were identified, which may help to target investigations. ILRs may have a central role in the future in the investigation of patients with unexplained stroke.
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Much longer monitoring using ILRs can further improve the diagnostic yield for syncope, as high as 85% in some studies.
“Much longer monitoring using ILRs can further improve the diagnostic yield for syncope, as high as 85% in some studies (Cotter et al., 2013).”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Cotter et al., 2013
The Discussion (page unavailable) says ILRs have primarily been used to investigate syncope, but its finding that longer monitoring improves diagnostic yield concerns atrial fibrillation after stroke, not syncope. The Results report AF detection in 25.5% of the stroke cohort; the Discussion’s 85.4% figure is device specificity for AF detection, not a diagnostic yield for syncope. (LLM, conf=0.88)
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- Authors
- Cotter, P. E., Martin, P. J., Ring, L., Warburton, E. A., Belham, M., & Pugh, P. J.
- Affiliations
- Cambridge University Hospitals NHS Foundation Trust (GB)
- Venue
- Neurology
- Published
- 2013-04-23
- Volume
- 80
- Issue
- 17
- Pages
- 1546-1550
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC3662328
- OpenAlex
- W2021263194
- Cited by
- 254
- References
- 19
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 10 · 2023: 11 · 2022: 18 · 2021: 25 · 2020: 11 · 2019: 21 · 2018: 18 · 2017: 21 · 2016: 26 · 2015: 29 · 2014: 44 · 2013: 9
- FWCI
- 24.45
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neurology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (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
- atrial fibrillation, implantable loop recorder, cryptogenic stroke, patent foramen ovale, left atrial volume, premature atrial contractions, atrial fibrillation risk factors, cardiac rhythm monitoring
- MeSH terms
- Adolescent, Adult, Aged, Atrial Fibrillation, Female, Humans, Male, Middle Aged, Monitoring, Physiologic, Cohort Studies, Incidence, Stroke, Young Adult
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