Impact of Insertable Cardiac Monitor-Detected Atrial Fibrillation on Future Ischemic Events Following Cryptogenic Stroke

Figure 1. Cumulative Incidence of AF Detection Cumulative incidence estimate for AF detection was 32% at 3 years (95% CI: 29.0%-36.4%). AF = atrial fibrillation.

Figure 2. Cumulative Incidence of Stroke Recurrence by AF Status Recurrent stroke risk at 3 years when treating AF as a time-varying exposure. The AF group is further stratified based on the timing of AF detection following the index ischemic event. The cumulative incidence of recurrent stroke was higher among patients with detected AF as compared to those without AF (HR: 1.76; 95% CI: 1.07-2.89; P = 0.026). Abbreviation as in Figure 1.

Central Illustration. ICM-Detected AF Following CS and Risk of Recurrent Ischemic Events In this retrospective study of 840 consecutive patients undergoing ICM implantation after CS, most recurrent strokes in this population occurred in patients with no AF ever detected, challenging the notion that most recurrent strokes in this population may be due to undetected AF. The likelihood of recurrent stroke was increased in patients with AF detected, despite most patients with AF being started on AC, regardless of duration. In exploratory subgroup analysis, patients <65 years of age and with a CHA2DS2-VASc score <4 may represent a low-risk group in whom deferral of ICM implantation may be reasonable. CHA2DS2-VASc = Congestive heart failure, Hypertension, Age ≥75 years, Diabetes, history of Stroke or transient ischemic attack, VAscular disease, Age 65-74 years, and Sex category (female); CS = cryptogenic stroke; ICM = insertable cardiac monitor; other abbreviation as in Figure 1.