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Prevalence and predictors of atrial fibrillation in patients with embolic stroke of undetermined source: a real-life single-center retrospective study

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Abstract

Introduction

Up to one-third of ischemic strokes remained cryptogenic despite extensive investigations. Atrial fibrillation may be detected in a significant proportion of patients with embolic stroke of undetermined source, particularly after the introduction of implantable loop recorder in clinical practice.

Methods

We retrospectively included all the consecutive patients with embolic stroke of undetermined source referred to our units in the period November 2013 to December 2018 and in which an implantable loop recorder was positioned within 6 months from stroke event. Prevalence and predictors of atrial fibrillation were investigated.

Results

One hundred thirty-eight patients with embolic stroke of undetermined source fulfilling inclusion criteria were identified. The crude prevalence of atrial fibrillation at the end of observation period was of 45.7%. Incidence rates at 6, 12, 18, 24, and 36 months resulted, respectively, 31.8% (95% CI, 30.4–46.7), 38.0% (95% CI, 30.4–46.9), 42.6% (95% CI, 34.5–51.6), 46.6% (95% CI, 38.2–55.8), and 50.4% (95% CI, 41.6–59.9). On multivariate analysis, only excessive supraventricular electric activity and left atrial enlargement resulted to be significant predictors of atrial fibrillation (p = 0.037 and p < 0.0001, respectively).

Conclusions

Atrial fibrillation may be detected in a relevant proportion (up to 50%) of patients with embolic stroke of undetermined source if a careful and extensive diagnostic work-up is employed. Excessive supraventricular electric activity and left atrial enlargement are significant predictors of the occurrence of atrial fibrillation in these patients.

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Correspondence to Daniele Imperiale.

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The present study was approved by the Comitato Etico Interaziendale AOU Città della Salute e della Scienza di Torino - AO Ordine Mauriziano d Torino - ASL Città di Torino and performed according to current Italian law.

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Melis, F., Guido, M., Amellone, C. et al. Prevalence and predictors of atrial fibrillation in patients with embolic stroke of undetermined source: a real-life single-center retrospective study. Neurol Sci 42, 3707–3714 (2021). https://doi.org/10.1007/s10072-020-04963-9

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