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Chousou, Panagiota A., Chattopadhyay, Rahul K., Matthews, Gareth 
ORCID: https://orcid.org/0000-0001-8353-4806, Clark, Allan ORCID: https://orcid.org/0000-0003-2965-8941, Vassiliou, Vassilios S. ORCID: https://orcid.org/0000-0002-4005-7752 and Pugh, Peter J.
(2024)
The incidence of atrial fibrillation detected by implantable loop recorders: A comparison between patients with and without embolic stroke of undetermined source.
European Heart Journal Open, 4 (5).
ISSN 2752-4191
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Abstract
Aims: Stroke is the most debilitating outcome of atrial fibrillation (AF). The use of implantable loop recorders increases the detection of AF episodes among patients with embolic stroke of undetermined source. The significance of device-detected AF, or subclinical AF, is unknown. This study aimed to compare the incidence of AF detected by implantable loop recorder in patients with and without embolic stroke of undetermined source. Methods and results: We retrospectively studied all patients without known AF who were referred to our institution for implantable loop recorder implantation following embolic stroke of undetermined source, syncope, or palpitations from March 2009 to November 2019. The primary endpoint was any detection of AF or atrial flutter by implantable loop recorder. Seven hundred and fifty patients were included and followed up for a mean duration of 731 days (SD 443). An implantable loop recorder was implanted following embolic stroke of undetermined source in 323 and for assessment of syncope, palpitations, or another reason in 427 patients. The incidence of AF was significantly (P < 0.001) higher among patients with embolic stroke of undetermined source compared with the non-embolic stroke of undetermined source group; 48.6% vs. 13.8% (for any duration of AF) and 32.2% vs. 12.4% (for AF lasting ≥30 s) both P < 0.001. Kaplan–Meier analysis showed significantly higher incidence of AF for incremental durations of AF up to >5.5 h, but not >24 h. This was driven by longest AF durations of <6 min and between 5.5 h and 24 h, suggesting a bimodal distribution. In a multivariable Cox regression analysis, embolic stroke of undetermined source independently conferred an almost 5-fold increase in the hazard for any duration of AF. Conclusion: The incidence of AF is significantly higher amongst embolic stroke of undetermined source vs. non-embolic stroke of undetermined source patients monitored constantly by an implantable loop recorder. A high number of embolic stroke of undetermined source survivors have short-duration AF episodes. Further work is needed to determine the optimal treatment strategy of these AF episodes in embolic stroke of undetermined source.
| Item Type: | Article |
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| Additional Information: | Data availability statement: Data are available on request. The data underlying this article will be shared on reasonable request to the corresponding author. Funding information: This work has been partially supported by the Norfolk Heart Trust. Prof V.S.V. reports lecturer fees from Daichii Sankyo, Novartis, and AstraZeneca within the last 5 years. Prof V.S.V. and Dr P.J.P. receive investigator-initiated research funding from Medtronic unrelated to this manuscript. Dr R.K.C. is supported by a Wellcome Trust PhD Fellowship. Dr G.M. is supported by an NIHR Clinical Lecturer award. |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health Faculty of Medicine and Health Sciences > Research Centres > Population Health Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health |
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| Depositing User: | LivePure Connector |
| Date Deposited: | 07 Aug 2024 16:30 |
| Last Modified: | 25 Sep 2024 18:00 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/96177 |
| DOI: | 10.1093/ehjopen/oeae061 |
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