Real-world experience with implantable loop recorder monitoring to detect subclinical atrial fibrillation in patients with cryptogenic stroke: The value of p wave dispersion in predicting arrhythmia occurrence

Marks, Daniel; Ho, Rady; Then, Ryna; Weinstock, Joshua Louis; Teklemariam, Ephrem; Kakadia, Bhavika; Collins, Jared A.; Andriulli, John; Hunter, Krystal; Ortman, Matthew; Russo, Andrea M.

doi:10.1016/j.ijcard.2020.11.019

Cited by 24 publications

(15 citation statements)

References 28 publications

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“…In the above-mentioned study a 30.0% detection rate was only achieved after 36 months of monitoring. (9) In the same manner, a lower detection rate of AF over an avera ge monitoring period of 365 days, compared to our results, was found by Marks et al (2019) in a retrospective study based on real practice. Using an ILR the authors detected a subclinical AF in 35 patients (19.6%) in a group of 178 patients with cryptogenic ischemic stroke.…”

Section: Discussionsupporting

confidence: 88%

“…Using an ILR the authors detected a subclinical AF in 35 patients (19.6%) in a group of 178 patients with cryptogenic ischemic stroke. (10) The detection rate of AF in our patients approximately correlates with the data of the meta-analysis of 28 studies processed by Tsivgoulis et al (2019) in patients with cryptogenic ischemic stroke and embolic stroke of underdetermined source (ESUS) (of which 10 studies monitored patients from 6 to 12 months). (11) The cumulative AF detection rate in patients with ILR was 26% of the above-mentioned meta-analysis.…”

Section: Discussionsupporting

confidence: 69%

“…90% (90) of patients had experienced a cryptogenic ischemic stroke with a moderate neurological deficit; the median NIHSS was 6.9 (0-15). The ratio of TIA in the patient group was 10% (10). The subjects in the patient group showed an average CHA2DS2-VASc score of 3 (2-5) and 1.4 (0-3) in the control group.…”

Section: Demographic Datamentioning

confidence: 83%

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Detection of Subclinical Paroxysmal Atrial Fibrillation and Its Correlation with Candidate Genes in Patients with Cryptogenic Ischemic Stroke and TIA

Petrovičová¹,

Kurča

Andrasova³

et al. 2021

Acta Medica Martiniana

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Introduction: Cardioembolic etiology is assumed to be the most frequent cause of cryptogenic strokes. The detection of subclinical paroxysmal atrial fibrillation (AF) is important in the correct choice of preventive treatment. The aim of this prospective study was to detect the incidence of AF in patients with a cryptogenic stroke or transient ischemic attack (TIA) and to evaluate the association between the presence of AF and selected single-nucleotide polymorphisms (SNP). Methods: Patients with a cryptogenic stroke/ TIA (n=100) and a control group (n=15) of volunteers without significant cardiovascular disease were included in the study during the period of 2014 to 2019. To detect AF they underwent 12 months of ECG monitoring using an implanted loop recorder (ILR). Genotyping for SNPs rs10033464, rs2200733, rs225132, and rs2106261 was performed by a high resolution melting analysis. Results: We found AF to be present in 24 (24%) patients with a cryptogenic stroke/TIA, versus no subjects in the control group. The SNPs rs2106261, rs2200733, rs225132, and rs10033464 were not found to be associated with AF in our study (p=0.240; 1.000; 0.887; 0.589). However, a weak trend for a higher frequency of rs2106261 risk allele A homozygotes was observed in the patients with AF compared to the patients without AF (0.416 vs. 0.263, p=0.073). Homozygotes for allele A of rs2106261 were also present in a significantly higher frequency in AF patients compared to the controls (0.416 vs. 0.133, p = 0.012). Conclusion: In our study paroxysmal AF was a probable etiological factor in 24% of patients with cryptogenic ischemic stroke / TIA during the 12 months of monitoring. The homozygous allele A of rs2106261 was identified to be the possible genetic risk factor of AF, but this should be verified in larger cohorts. The study has been registered at www.clinicaltrials.gov, identifier NCT02216370.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 69%

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Detection of Subclinical Paroxysmal Atrial Fibrillation and Its Correlation with Candidate Genes in Patients with Cryptogenic Ischemic Stroke and TIA

Petrovičová¹,

Kurča

Andrasova³

et al. 2021

Acta Medica Martiniana

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“…Early observational studies showed that rates of detection for paroxysmal AF following cryptogenic stroke were directly related to duration of monitoring, ranging from 3 to 7% on shorter-term ECG and telemetry, to up to 30% after 3 years of monitoring with implantable loop recorders—trends later confirmed in two randomized trials [ 14 – 17 ]. Subsequent studies identified factors associated with increased likelihood of detection including older age, cortical appearance of stroke on cerebral imaging, and higher CHA 2 DS 2 -VASc score, as well as markers of left atrial disease including elevated N-terminal pro-brain natriuretic peptide (NT-pro-BNP), P wave dispersion on ECG, and left atrial dilation [ 18 , 19 , 20 •, 21 ].…”

Section: Paroxysmal Atrial Fibrillationmentioning

confidence: 99%

Stroke Prevention After Cryptogenic Stroke

Elkind

2021

Curr Cardiol Rep

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Purpose of Review Cryptogenic stroke represents a heterogenous but clinically important collection of stroke etiologies for which our understanding continues to grow. Here, we review our current knowledge and most recent recommendations on secondary prevention for common causes of cryptogenic stroke including paroxysmal atrial fibrillation, atrial cardiopathy, patent foramen ovale, and substenotic atherosclerotic disease as well as the under-recognized mechanisms of occult malignancy, heart failure, and, most recently, infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Recent Findings The results from recent observational studies and randomized clinical trials have provided greater insight into the causal relationship and attributable risk of these suspected etiologies and have identified potential strategies to reduce the rates of recurrence. However, further clinical trials are needed to confirm the benefits of specific stroke prevention strategies, including the patient populations most likely to benefit from anticoagulation. Summary There is ongoing research aimed at both reducing the proportion of ischemic strokes classified as cryptogenic and resolving much of the clinical equipoise that still exists. The results of these studies have the potential to provide us with a better understanding of these occult mechanisms and allow for more targeted interventions.

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“…P‐Wave Dispersion (PWD) is a non‐invasive parameter defined as the difference between the longest and the shortest P‐Wave duration on the surface electrocardiogram (ECG), 1 , 2 which has been investigated in atrial fibrillation (AF), hypertension, and stroke. 3 , 4 , 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

Global cognitive function correlates with P‐wave dispersion in frail hypertensive older adults

Mone

Pansini

Calabrò

et al. 2022

J of Clinical Hypertension

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P-Wave Dispersion (PWD) is an ECG parameter defined as the difference between the longest and the shortest P-Wave duration. PWD has been associated with hypertension, a leading cause of age-related cognitive decline. Moreover, hypertension is associated with vascular dementia and Alzheimer's Disease. Based on these considerations, we evaluated PWD and global cognitive function in frail hypertensive older adults with a previous diagnosis of cognitive decline. We evaluated consecutive frail hypertensive patients ≥65-year-old with a Mini-Mental State Examination (MMSE) score <26. Patients with evidence of secondary hypertension, history of stroke, myocardial infarction, or therapy with beta-blockers or acetylcholinesterase inhibitors were excluded. Beta-blocker therapy causes a significant decrease in PWD; patients treated with acetylcholinesterase inhibitors were not included to avoid confounding effects on cognitive function. By examining 180 patients, we found that PWD significantly correlated with MMSE score. Strikingly, these effects were confirmed in a linear multivariate analysis with a regression model. To our knowledge, this is the first study showing that PWD correlates with global cognitive function in frail hypertensive older adults.

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Real-world experience with implantable loop recorder monitoring to detect subclinical atrial fibrillation in patients with cryptogenic stroke: The value of p wave dispersion in predicting arrhythmia occurrence

Cited by 24 publications

References 28 publications

Detection of Subclinical Paroxysmal Atrial Fibrillation and Its Correlation with Candidate Genes in Patients with Cryptogenic Ischemic Stroke and TIA

Detection of Subclinical Paroxysmal Atrial Fibrillation and Its Correlation with Candidate Genes in Patients with Cryptogenic Ischemic Stroke and TIA

Stroke Prevention After Cryptogenic Stroke

Global cognitive function correlates with P‐wave dispersion in frail hypertensive older adults

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