Key result
ICM detects subclinical AF in ~29% of cryptogenic stroke patients over long-term follow-up.
Why the study?
Long-term real-world data on insertable cardiac monitor detection of subclinical atrial fibrillation and subsequent therapy in cryptogenic stroke patients are limited.
Does long-term continuous monitoring with insertable cardiac monitors detect subclinical atrial fibrillation in cryptogenic stroke patients?
Cohort (n=789)
Yes
Does long-term continuous monitoring with insertable cardiac monitors detect subclinical atrial fibrillation in cryptogenic stroke patients?
Long-term monitoring with insertable cardiac monitors in cryptogenic stroke patients detects subclinical atrial fibrillation in approximately one-third of patients by 48 months, frequently leading to the initiation of anticoagulation.
Supports ICM monitoring in CS; leaves open whether anticoagulation reduces recurrent stroke.
Background Long‐term continuous monitoring with insertable cardiac monitor (ICM) is recommended after cryptogenic stroke (CS) by current guidelines to detect subclinical atrial fibrillation (SCAF). However, long‐term real‐world data on ICM‐SCAF detection and ensuing therapy are limited. The aim of this study was to assess long‐term SCAF detection rate in a large cohort of CS patients with ICM. Methods Data of consecutive CS patients receiving ICM from September 2016 to February 2024 in 20 Italian centers were collected. Patients were followed with remote and outpatient follow‐up according to clinical practice. SCAF was diagnosed if a device‐detected SCAF daily burden ≥ 5 min was confirmed by a cardiologist. Results Seven hundred and eighty‐nine CS patients with ICM (mean age 69.3 ± 11.7 years, 40.3% females, 79.0% CHA 2 DS 2 ‐VASc score ≥ 4) were monitored for a mean of 27.3 (IQR:14.2–42.5) months after index stroke. SCAF was diagnosed in 229 (29.0%) patients, with a cumulative detection rate of 37.0% (IQR: 32.9%–41.5%) 48 months after the stroke, and was asymptomatic in 198 (86.5%). Sixty‐eight (29.7%) patients had one or more days with a 24‐h SCAF burden. Median time from index stroke to SCAF diagnosis was 6.9 (IQR: 2.1–17.0) months. After SCAF diagnosis, anticoagulants were prescribed to 210 (95.9%) patients out of 219 not already assuming them at baseline. CHA 2 DS 2 ‐VASc ≥ 5, anterior circulation stroke, and cortical lesions were independent predictors of SCAF diagnosis. Conclusions This multicenter real‐world project confirmed that ICM allows the detection of SCAF in one third of CS patients 48 months after the stroke, leading to anticoagulation in most of them.
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Pantoni et al. (2025) conducted a cohort in Cryptogenic stroke (n=789). Insertable cardiac monitor was evaluated on Subclinical atrial fibrillation (SCAF) detection. Long-term monitoring with an insertable cardiac monitor detected subclinical atrial fibrillation in 29.0% of cryptogenic stroke patients over a mean follow-up of 27.3 months.
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