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AF Risk Increases Over Time in Patients With Stroke Attributed to LAD, SVD
Atrial fibrillation (AF) detection rose from 12.5% at 1 year to 21.7% in 3 years in patients with stroke attributed to large-artery atherosclerotic disease (LAD) and small-vessel occlusive disease (SVD) who were monitored with an insertable cardiac monitor (ICM), according to a study published in JAMA Neurology.
“One year of negative monitoring should not reassure clinicians that patients who have experienced stroke will not develop AF over the next 2 years,” wrote corresponding author Richard A. Bernstein, MD, PhD, of the Feinberg School of Medicine of Northwestern University, Chicago, Illinois, and study coauthors.
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The study investigated rates of detected AF over 3 years in 492 patients with prior ischemic stroke attributed to LAD or SVD. Patients were randomized to ICM or site-specific usual care at 33 sites in the United States. Among participants, the median age was 66 years, 37.6% were women, and 314 completed follow-up at 3 years.
AF incidence rates at 3 years were 21.7% with ICM compared with 2.4% with usual care despite the performance of numerous, intermittent heart rhythm recordings, according to the study.
In the ICM group, AF episodes tended to be asymptomatic. Many patients had at least 1 AF episode that lasted longer than 1 hour. Of participants with at least 6 minutes of AF burden, two-thirds had AF burden progression over the course of monitoring.
Left atrial enlargement, heart failure, obesity, and prolonged QRS duration were risk factors for ICM detection of AF, the study found.
“In summary, patients with ischemic stroke attributed to LAD or SVD face an increasing risk of AF over time and most of the AF occurrences are not reliably detected by standard medical monitoring methods,” researchers wrote.
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