Evaluation of organized atrial arrhythmias after cryptogenic stroke

Naga Venkata K Pothineni; Uyanga Batnyam; Hannah Schwennesen; Ann Tierney; Steven R Messé; Brett Cucchiara; Todd B Mendelson; Jeffrey J Luebbert; Wei Yang; Ramanan Kumareswaran; Matthew C Hyman; David Lin; Sanjay Dixit; Andrew E Epstein; Jeffrey S Arkles; Saman Nazarian; Robert D Schaller; Gregory E Supple; David Callans; Amaryah Yaeger; David S Frankel; Pasquale Santangeli; Scott E Kasner; Francis E Marchlinski; Rajat Deo

doi:10.1016/j.hroo.2023.11.016

Evaluation of organized atrial arrhythmias after cryptogenic stroke

Heart Rhythm O2. 2023 Dec 2;5(1):34-40. doi: 10.1016/j.hroo.2023.11.016. eCollection 2024 Jan.

Authors

Naga Venkata K Pothineni¹, Uyanga Batnyam¹, Hannah Schwennesen¹, Ann Tierney², Steven R Messé³, Brett Cucchiara³, Todd B Mendelson¹, Jeffrey J Luebbert¹, Wei Yang², Ramanan Kumareswaran¹, Matthew C Hyman¹, David Lin¹, Sanjay Dixit¹, Andrew E Epstein¹, Jeffrey S Arkles¹, Saman Nazarian¹, Robert D Schaller¹, Gregory E Supple¹, David Callans¹, Amaryah Yaeger¹, David S Frankel¹, Pasquale Santangeli¹, Scott E Kasner³, Francis E Marchlinski¹, Rajat Deo¹

Affiliations

¹ Division of Cardiovascular Medicine, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
² Department of Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
³ Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

Background: Long-term rhythm monitoring to detect atrial fibrillation (AF) following a cryptogenic stroke (CS) is well established. However, the burden of organized atrial arrhythmias in this population is not well defined.

Objective: The purpose of this study was to assess the incidence and risk factors for organized atrial arrhythmias in patients with CS.

Methods: We evaluated all patients with CS who received an insertable cardiac monitor (ICM) between October 2014 and April 2020. All ICM transmissions categorized as AF, tachycardia, or bradycardia were reviewed. We evaluated the time to detection of organized AF and the combination of either organized atrial arrhythmia or AF.

Results: A total of 195 CS patients with ICMs were included (51% men; mean age 66 ± 12 years; mean CHA₂DS₂-VAS_C score 4.6). Over mean follow-up of 18.9 ± 11.2 months, organized atrial arrhythmias lasting ≥30 seconds were detected in 45 patients (23%), of whom 62% did not have AF. Seventeen patients had both organized atrial arrhythmia and AF, and another 21 patients had AF only. Compared to those with normal left atrial size, patients with left atrial enlargement had a higher adjusted risk for development of atrial arrhythmias (mild left atrial enlargement: hazard ratio 1.99; 95% confidence interval 1.06-3.75; moderate/severe left atrial enlargement: hazard ratio 3.06; 95% confidence interval 1.58-5.92).

Conclusion: Organized atrial arrhythmias lasting ≥30 seconds are detected in nearly one-fourth of CS patients. Two-thirds of these patients did not have AF. Further studies are required to evaluate the impact of organized atrial arrhythmias on recurrent stroke risk.

Keywords: Atrial fibrillation; Atrial flutter; Cryptogenic stroke; Insertable cardiac monitor; Organized atrial arrhythmias.