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Atrial fibrillation detected by mobile cardiac outpatient telemetry in cryptogenic TIA or stroke

From the Department of Neurology and Allegheny General Hospital Stroke Center (A.H.T., M.T., K.M.K., S.C.J., D.G.W., D.S., J.J., J.B.), and Division of Cardiology, Department of Medicine (S.M.), Allegheny General Hospital, Pittsburgh, PA; Department of Anesthesiology (S.C.J.), Drexel University College of Medicine (A.H.T., K.M.K., S.C.J., D.G.W., J.B., S.M.), Philadelphia, PA; and Department of Neurology (R.G.), Cleveland Clinic Foundation, OH.

Address correspondence and reprint requests to Dr. Ashis H. Tayal, Allegheny General Hospital, Comprehensive Stroke Center, 420 East North Avenue, Suite 206, Pittsburgh, PA 15212 atayal{at}wpahs.org.

Objective: Atrial fibrillation (AF) may be present within a subset of patients with presumed cryptogenic TIA or stroke and remains undetected by standard diagnostic methods. We hypothesized that AF may be an under-recognized mechanism for cryptogenic TIA/stroke.

Methods: A consecutive series of 56 patients with cryptogenic TIA/stroke was analyzed after diagnostic evaluation and Mobile Cardiac Outpatient Telemetry (MCOT) for up to 21 days. Demographic, radiographic, echocardiographic, and MCOT results were reviewed. Predictors of AF detection by MCOT were determined by univariate analysis including Student t test and Fisher exact tests and multivariate analysis.

Results: The median MCOT monitoring duration was 21 (range 5–21) days resulting in an AF detection rate of 23% (13/56). AF was first detected after a median of 7 (range 2–19) days of monitoring. Twenty-seven asymptomatic AF episodes were detected in the 13 patients, of which 85% (23/27) were <30 seconds and the remaining 15% (4/27) were 4–24 hours in duration. Diabetes was predictive of AF detection by both univariate (p = 0.024) and multivariate analysis (OR 6.15; 95% CI 1.16 to 32.73; p = 0.033).

Conclusions: There is a high rate of atrial fibrillation (AF) detection by Mobile Cardiac Outpatient Telemetry (21 days) in patients with cryptogenic TIA/stroke that may be related to extended monitoring duration, patient selection, and inclusion of all new onset AF episodes. Brief AF episodes (<30 seconds) may be biomarkers of more prolonged and clinically significant AF.

Abbreviations: AF = atrial fibrillation; ASA = atrial septal aneurysm; AV = Mobitz type 2 second degree atrioventricular block; DWI = diffusion weighted imaging; ECG = electrocardiogram; ELR = event-loop recording; HR = heart rate; MCOT = Mobile Cardiac Outpatient Telemetry; NSVT = nonsustained ventricular tachycardia; PAC = premature atrial complex; PAF = paroxysmal atrial fibrillation; PFO = patent foramen ovale; PSVT = paroxysmal supraventricular tachycardia; TEE = transesophageal echocardiography; TOAST = Trial of Org 10172 in Acute Stroke Treatment; TTE = transthoracic echocardiography.

e-Pub ahead of print on September 24, 2008, at www.neurology.org.

Disclosure: The authors report no disclosures.

Received December 21, 2007. Accepted in final form June 3, 2008.