Key result
Subclinical paroxysmal atrial fibrillation was detected in 24% of patients with cryptogenic ischemic stroke or TIA during 12 months of implantable loop recorder monitoring, compared to 0% in healthy controls.
Why the study?
Cardioembolic etiology is presumed common in cryptogenic stroke, making detection of subclinical paroxysmal AF important for choosing preventive therapy.
Does 12-month monitoring with an implantable loop recorder detect subclinical paroxysmal atrial fibrillation and correlate with candidate genes in patients with cryptogenic ischemic stroke and TIA?
Observational (n=115)
Yes
Does 12-month monitoring with an implantable loop recorder detect subclinical paroxysmal atrial fibrillation and correlate with candidate genes in patients with cryptogenic ischemic stroke and TIA?
Long-term ECG monitoring with an implantable loop recorder detected subclinical paroxysmal atrial fibrillation in 24% of patients with cryptogenic stroke/TIA, and the homozygous allele A of rs2106261 may represent a genetic risk factor for AF in this population.
Extended ILR monitoring may identify subclinical AF in cryptogenic stroke; leaves open genetic risk factor confirmation.
Introduction: Cardioembolic etiology is assumed to be the most frequent cause of cryptogenic strokes. The detection of subclinical paroxysmal atrial fibrillation (AF) is important in the correct choice of preventive treatment. The aim of this prospective study was to detect the incidence of AF in patients with a cryptogenic stroke or transient ischemic attack (TIA) and to evaluate the association between the presence of AF and selected single-nucleotide polymorphisms (SNP). Methods: Patients with a cryptogenic stroke/ TIA (n=100) and a control group (n=15) of volunteers without significant cardiovascular disease were included in the study during the period of 2014 to 2019. To detect AF they underwent 12 months of ECG monitoring using an implanted loop recorder (ILR). Genotyping for SNPs rs10033464, rs2200733, rs225132, and rs2106261 was performed by a high resolution melting analysis. Results: We found AF to be present in 24 (24%) patients with a cryptogenic stroke/TIA, versus no subjects in the control group. The SNPs rs2106261, rs2200733, rs225132, and rs10033464 were not found to be associated with AF in our study (p=0.240; 1.000; 0.887; 0.589). However, a weak trend for a higher frequency of rs2106261 risk allele A homozygotes was observed in the patients with AF compared to the patients without AF (0.416 vs. 0.263, p=0.073). Homozygotes for allele A of rs2106261 were also present in a significantly higher frequency in AF patients compared to the controls (0.416 vs. 0.133, p = 0.012). Conclusion: In our study paroxysmal AF was a probable etiological factor in 24% of patients with cryptogenic ischemic stroke / TIA during the 12 months of monitoring. The homozygous allele A of rs2106261 was identified to be the possible genetic risk factor of AF, but this should be verified in larger cohorts. The study has been registered at www.clinicaltrials.gov , identifier NCT02216370.
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Petrovičová et al. (2021) conducted an observational in Cryptogenic ischemic stroke and TIA (n=115). Cryptogenic ischemic stroke or TIA vs. Volunteers without significant cardiovascular disease was evaluated on Detection of subclinical paroxysmal atrial fibrillation. Subclinical paroxysmal atrial fibrillation was detected in 24% of patients with cryptogenic ischemic stroke or TIA during 12 months of implantable loop recorder monitoring, compared to 0% in healthy controls.
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