Key result
Large-vessel occlusion linked to ~4-fold higher odds of late-detected AF in cryptogenic stroke.
Why the study?
Occult AF is frequently identified only after hospital discharge in patients with cryptogenic stroke, but the clinical characteristics of late-detected AF remain unclear.
What are the clinical characteristics and predictors of late-detected atrial fibrillation (>30 days) in patients with cryptogenic stroke undergoing insertable cardiac monitoring?
Observational (n=128)
Yes
What are the clinical characteristics and predictors of late-detected atrial fibrillation (>30 days) in patients with cryptogenic stroke undergoing insertable cardiac monitoring?
Odds Ratio: 4.137 (95% CI 1.301–13.153)
Absolute Event Rate: 26.5% vs 10.5%
p-value: p=0.016
In patients with cryptogenic stroke, older age and large-vessel occlusion are independent predictors of late-detected atrial fibrillation (>30 days), highlighting the need for prolonged rhythm monitoring in these high-risk subgroups.
Older CS patients with LVO may warrant extended ICM monitoring; leaves open predictors and optimal duration of rhythm surveillance.
Introduction Occult atrial fibrillation (AF) is a major underlying cause of cryptogenic stroke (CS) and is frequently identified only after hospital discharge. However, the characteristics of late-detected AF remain unclear. In this study, we aimed to investigate the clinical characteristics of patients with late-detected AF identified >30 days after the onset of stroke, compared with those without AF detection. Methods Data from patients with CS who underwent implantation of an insertable cardiac monitor in the multicenter LOOK study were analyzed. Patients were categorized into three groups. Early-detected (within 30 days), Late-detected (after 30 days), and No-detected AF. Clinical characteristics were primarily compared between the Late-detected and No-detected AF groups, with additional exploratory comparisons involving the Early-detected AF group. Results AF was detected in 42 (32.8%) of the 128 patients (median age, 71 years; 68.0% male). Eight patients were classified into the Early-detected AF group, 34 into the Late-detected AF group, and 86 into the No-detected AF group. Compared with the no-detected AF group, patients in the late-detected AF group were older (78 vs. 66 years, p < 0.001) and had lower hyperlipidemia rates (17.6% vs. 39.5%, p = 0.03), but higher rates of large-vessel occlusion (26.5% vs. 10.5%, p = 0.01) and D-dimer levels (1.1 vs. 0.7 μg/mL, p = 0.04). The modified Rankin Scale score before insertable cardiac monitor implantation tended to be lower in the late-detected AF group than in the early-detected AF group ( p = 0.05). Discussion Patients with CS and late-detected AF, compared with those without AF detection, were older, had fewer atherosclerotic risk factors, and more frequently had large-vessel occlusion. These findings highlight the importance of long-term rhythm monitoring after stroke in patients at higher risk of late-detected AF.
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Katano et al. (2026) conducted an observational in Cryptogenic stroke (n=128). Late-detected atrial fibrillation (>30 days post-stroke) vs. No-detected atrial fibrillation was evaluated on Large-vessel occlusion (OR 4.137, 95% CI 1.301-13.153, p=0.016). In patients with cryptogenic stroke, large-vessel occlusion was independently associated with a more than four-fold increased odds of late-detected atrial fibrillation (OR 4.137).
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