Key result
Cryptogenic stroke or TIA is linked to ~214% higher odds of SND versus controls.
Why the study?
Implantable loop recorders are used primarily to detect atrial fibrillation after cryptogenic stroke, but the burden of bradyarrhythmias in these patients is not well established.
Does a history of cryptogenic stroke or TIA predict a higher incidence of clinically significant sinus node dysfunction in patients monitored with implantable loop recorders?
Cohort (n=225)
Does a history of cryptogenic stroke or TIA predict a higher incidence of clinically significant sinus node dysfunction in patients monitored with implantable loop recorders?
Patients with cryptogenic stroke have a significantly higher incidence of clinically relevant sinus node dysfunction detected by loop recorders, suggesting an underlying atrial cardiomyopathy beyond just atrial fibrillation.
Hypothesis-generating for SND in cryptogenic stroke; prospective studies needed before changing ILR practices.
BACKGROUND: Cryptogenic stroke (CS) is often associated with atrial fibrillation (AF), but may also reflect a broader atrial pathology such as atrial cardiomyopathy. Although implantable loop recorders (ILRs) are used primarily to detect AF in these patients, the burden of bradyarrhythmias is not well established. OBJECTIVE: This study aimed to evaluate the prevalence and clinical significance of bradyarrhythmias in patients implanted with ILRs after CS or transient ischemic attack (TIA) compared with a matched control population with ILRs for other indications. METHODS: We retrospectively analyzed 225 patients receiving ILRs for CS/TIA (n = 139) or other indications excluding syncope (n = 86). Bradyarrhythmias were classified according to the European Society of Cardiology 2021 guidelines. A 1:1 propensity score matching was performed based on major covariates. The primary end point was the time to the first detection of clinically significant sinus node dysfunction (SND). RESULTS: During a median follow-up of 23 months, SND occurred more frequently in the CS group than in controls (18.7% vs 4.7%; P = .003). After propensity score matching (n = 114), SND remained significantly more prevalent in patients with stroke (22.8% vs 8.8%; P = .04). Univariate analysis identified CS/TIA (odds ratio 3.14; 95% confidence interval 1.02-9.64; P = .045), hypertension, and increased indexed left atrial volume as independent predictors of SND. Kaplan-Meier analysis showed a significantly lower event-free survival for SND in the CS group (log-rank P = .034). CONCLUSION: Patients with CS show a significantly higher and earlier incidence of clinically relevant SND than matched controls, which may suggest an underlying atrial remodeling process consistent with atrial cardiomyopathy. These findings underscore the importance of comprehensive arrhythmic monitoring beyond AF in this population.
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Bencardino et al. (2026) conducted a cohort in Cryptogenic stroke or transient ischemic attack (n=225). Cryptogenic stroke or TIA vs. ILR for other indications excluding syncope was evaluated on time to the first detection of clinically significant sinus node dysfunction (SND) (OR 3.14, 95% CI 1.02-9.64, p=0.045). Patients with cryptogenic stroke or TIA had a significantly higher prevalence of sinus node dysfunction compared to matched controls with ILRs for other indications (22.8% vs 8.8%; P=0.04).
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