Detection of Atrial Fibrillation Among Patients With Stroke Due to Large or Small Vessel Disease: A Meta‐Analysis

Demeestere, Jelle; Fieuws, Steffen; Lansberg, Maarten G.; Lemmens, Robin

doi:10.1161/jaha.116.004151

Cited by 19 publications

(12 citation statements)

References 48 publications

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“…Similar results were shown in cases of ischemic stroke patients with AF detected for the first time by long-term ECG, with 10.9% of them showing a lacunar infarct pattern. In agreement with our results, it is known that a small percentage of patients with a lacunar infarct pattern present with AF [30, 31]. Consequently, a lacunar infarct pattern in patients without risk factors for microangiopathy should not be considered as an exclusion criterion for ICM insertion in patients with cryptogenic stroke, especially because AF detection in patients with lacunar infarcts is less probable than in patients with non-lacunar infarcts [20].…”

Section: Discussionsupporting

confidence: 88%

MR-imaging pattern is not a predictor of occult atrial fibrillation in patients with cryptogenic stroke

et al. 2019

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BackgroundTo date, insertable cardiac monitors (ICMs) are the most effective method for the detection of occult atrial fibrillation (AF) in cryptogenic stroke. The overall detection rate after 12 months, however, is low and ranges between 12.4 and 33.3%, even if clinical predictors are considered. Ischemic stroke patients due to cardiogenic embolism present with particular lesion patterns. In patients with cryptogenic stroke, MR-imaging pattern may be a valuable predictor for AF.MethodsThis is an MRI-based, retrospective, observational, comparative, single-center study of 104 patients who underwent ICM implantation after cryptogenic stroke. The findings were compared to a reference group with related stroke etiology, i.e., 166 patients with embolic stroke due to AF detected for the first time by long-term ECG. Lesion patterns were evaluated with regard to affected territories, distribution (cortical, lacunar, scattered), lesion volume, and lesion size (diameter of the lesion size > 20 mm).ResultsThe MR-imaging analysis of acute ischemic lesions yielded no association between AF and lesion size or volume, arterial vessel distribution, or the number of affected territories. There was no significant difference between the cohorts regarding ischemic patterns (cortical lesions, scattered lesions, and lacunar infarcts). An important clinical inference of our findings is that 10% (2 of 20) of cases in the ICM group in whom AF was detected had a lacunar infarct pattern. Similar results were shown in cases of ischemic stroke patients with AF detected for the first time by long-term ECG, with 10.9% (16 of 147) of them showing lacunar infarcts. The analysis of chronic MRI lesions revealed no differences between the groups in the rate of chronic lesions, arterial vessel distribution, or the number of affected territories. Left atrial size (LA size) and the presence of atrial runs in long-term ECG were independently associated with AF.ConclusionsIn this MRI-based analysis of patients with cryptogenic stroke who had received ICM implantation, the detection rate of AF in patients with ICM was not related to the imaging pattern. In addition, the lacunar infarct pattern should not be an exclusion criterion for ICM insertion in patients with cryptogenic stroke. ICM insertion in patients with cryptogenic stroke should not be evaluated solely on the basis of reference to infarct patterns.

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Section: Discussionsupporting

confidence: 88%

MR-imaging pattern is not a predictor of occult atrial fibrillation in patients with cryptogenic stroke

et al. 2019

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“…Haemorrhagic transformation is probably also characteristic of cardiac embolism since cardiac, ‘red’ (fibrin-rich) thrombi are more liable to re-perfuse and consequently to have associated haemorrhage within the infarct. However, none of these findings is wholly reliable: even small subcortical infarction may occur in the presence of a definite embolic mechanism,38 and a recent meta-analysis showed that the AF detection rate at 7 days after ischaemic stroke is similar whether the stroke is classified clinicoradiologically as due to small or large vessel occlusion 39. Importantly, trials of prolonged monitoring gave high detection rates in relatively unselected patients with cryptogenic stroke.…”

Section: Diagnosis Of Af After Strokementioning

confidence: 99%

Atrial fibrillation and stroke: a practical guide

et al. 2019

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Neurologists and stroke physicians will be familiar with atrial fibrillation as a major cause of ischaemic stroke, and the role of anticoagulation in preventing cardioembolic stroke. However, making decisions about anticoagulation for individual patients remains a difficult area of clinical practice, balancing the serious risk of ischaemic stroke against that of major bleeding, particularly intracranial haemorrhage. Atrial fibrillation management requires interdisciplinary collaboration with colleagues in cardiology and haematology. Recent advances, especially the now-widespread availability of direct oral anticoagulants, have brought opportunities to improve stroke care while posing new challenges. This article gives an overview of the contemporary diagnosis and management of atrial fibrillation, and the associated evidence base. Where there is uncertainty, we describe our own approach to these areas, while highlighting ongoing research that will likely guide future practice.

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“…Third, the subtype of ischaemic stroke could not be determined using the ICD‐9 codes. The AF detection rate is similar in patients with small and large vessel stroke events, but it is relatively high in cryptogenic stroke . Therefore, the mechanism of stroke might affect the rates of AF detection and recurrent stroke.…”

Section: Discussionmentioning

confidence: 99%

“…The AF detection rate is similar in patients with small and large vessel stroke events, but it is relatively high in cryptogenic stroke. 22 Therefore, the mechanism of stroke might affect the rates of AF detection and recurrent stroke. Fourth, the actual number of deaths in delayed AF diagnosis group was small, thus limiting the statistical power in the analysis of all-cause mortality.…”

Section: Discussionmentioning

confidence: 99%

Delayed diagnosis of atrial fibrillation after first‐ever stroke increases recurrent stroke risk: a 5‐year nationwide follow‐up study

Chou

Chan

et al. 2018

Internal Medicine Journal

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Detection of Atrial Fibrillation Among Patients With Stroke Due to Large or Small Vessel Disease: A Meta‐Analysis

Cited by 19 publications

References 48 publications

MR-imaging pattern is not a predictor of occult atrial fibrillation in patients with cryptogenic stroke

MR-imaging pattern is not a predictor of occult atrial fibrillation in patients with cryptogenic stroke

Atrial fibrillation and stroke: a practical guide

Delayed diagnosis of atrial fibrillation after first‐ever stroke increases recurrent stroke risk: a 5‐year nationwide follow‐up study

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