Paroxysmal Atrial Fibrillation in Cryptogenic Stroke Patients With Major-Vessel Occlusion

Ryosuke Doijiri; Hiroshi Yamagami; Masafumi Morimoto; Tomonori Iwata; Tetsuya Hashimoto; Kazutaka Sonoda; Hidekazu Yamazaki; Junpei Koge; Naoto Kimura; Kenichi Todo

doi:10.3389/fneur.2020.580572

Paroxysmal Atrial Fibrillation in Cryptogenic Stroke Patients With Major-Vessel Occlusion

Front Neurol. 2020 Nov 12:11:580572. doi: 10.3389/fneur.2020.580572. eCollection 2020.

Authors

Ryosuke Doijiri¹, Hiroshi Yamagami^{2

3}, Masafumi Morimoto⁴, Tomonori Iwata^{5

6}, Tetsuya Hashimoto⁶, Kazutaka Sonoda^{2

6}, Hidekazu Yamazaki⁴, Junpei Koge^{2

6}, Naoto Kimura⁷, Kenichi Todo⁸

Affiliations

¹ Department of Neurology, Iwate Prefectural Central Hospital, Morioka, Japan.
² Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan.
³ Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
⁴ Department of Neurosurgery, Yokohama Shintoshi Hospital, Yokohama, Japan.
⁵ Department of Neurology, Tokai University, Isehara, Japan.
⁶ Department of Neurology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan.
⁷ Department of Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Japan.
⁸ Department of Neurology, Osaka University, Suita, Japan.

Abstract

Background and Purpose: To determine whether acute major-vessel occlusion (MVO) predicts atrial fibrillation (AF) in cryptogenic stroke (CS) patients, we analyzed the association between acute MVO and AF detected by insertable cardiac monitoring (ICM). Methods: We conducted a retrospective, multicenter, observational study of patients with CS who underwent ICM implantation between October 2016 and March 2018. In this analysis, we included follow-up data until June 2018. We analyzed the association of MVO with AF detected by ICM. Results: We included 84 consecutive patients with CS who underwent ICM implantation. The proportion of patients with newly detected AF by ICM was higher in patients with MVO than in those without (41% [12/29] vs. 13% [7/55], p < 0.01) within 90 days of ICM implantation. The MVO was associated with AF after adjustment for each clinically relevant factor. Conclusions: MVO was independently associated with AF detection in patients with CS, which suggests that MVO may be a useful predictor of latent AF. It is therefore essential to actively assess latent AF in patients with CS presenting with MVO.

Keywords: cryptogenic stroke; insertable cardiac monitors; major-vessel occlusion; paroxysmal atrial fibrillation; stroke recurrence.