Key result
Older age is linked to ~5% faster AF detection per year after cryptogenic stroke.
Why the study?
Implantable loop recorders detect occult AF after cryptogenic stroke, but many patients do not manifest AF, prompting the need to identify factors associated with detection to improve device specificity.
Cohort (n=744)
No
Hazard Ratio: 1.05 (95% CI 1.03–1.07)
p-value: p=<0.001
Older age, tricuspid regurgitation, and middle cerebral artery stroke are independent predictors of atrial fibrillation detection by implantable loop recorders in patients with cryptogenic stroke.
May inform age-based ILR monitoring decisions after cryptogenic stroke; leaves open whether targeted strategies improve outcomes.
Background Implantable loop recorders (ILR) assist in detecting occult atrial fibrillation (AF) in patients with cryptogenic stroke, yet many patients do not manifest subsequent AF. Objective To identify factors associated with ILR-detected AF, thereby improving device specificity. Methods All 744 patients implanted with ILRs at our Stroke Center from 2014-2025 after ischemic cryptogenic stroke were followed for AF episodes ≥6 minutes and recurrent stroke. Results During 657 ± 450 (median 591) days, 138 (18.5%) patients manifested AF ≥6 minutes, with highest risk within the first 6 months. Older age (HR 1.05 per year, 95% CI 1.03-1.07; p<0.001), tricuspid regurgitation (HR 1.61, 95% CI 1.10-2.35; p=0.015), and middle cerebral artery stroke (HR 1.79, 95% CI 1.18-2.71; p=0.006) were independently associated with shorter time to initial AF. Multivessel strokes were not associated with AF detection. In the oldest age quartile (≥76), 28% manifested AF; mitral regurgitation, tricuspid regurgitation, and β-blocker use were associated with shorter time to initial AF. In the middle two age quartiles (57-75), 18% had detected AF; middle cerebral artery stroke was independently associated with AF risk. Only 6% in the youngest age quartile (≤56) manifested AF. Of 44 patients with recurrent stroke, 6 had detected AF. Stroke was temporally related to AF in two patients. Conclusion Older age is highly associated with subsequent AF detection in cryptogenic stroke. Mitral and tricuspid regurgitation and middle cerebral artery strokes are associated with AF in older and middle-aged patients, respectively. Recurrent stroke rarely was associated with temporally related AF.
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Adelstein et al. (2026) conducted a cohort in Ischemic cryptogenic stroke (n=744). Older age vs. Younger age was evaluated on Time to initial atrial fibrillation episode ≥6 minutes (HR 1.05, 95% CI 1.03-1.07, p=<0.001). Older age was independently associated with a shorter time to initial atrial fibrillation detection after cryptogenic stroke (HR 1.05 per year; 95% CI 1.03-1.07; p<0.001).
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