Uncovering AF

High Rates of AF Detected with Continuous Cardiac Monitoring Following Atherosclerotic Stroke

New data presented at the International Stroke Conference (ISC) 2023 suggest there may be value in continuously monitoring patients for AF following an atherosclerotic stroke, instead of just those with cryptogenic stroke.

The 3-year results from the STROKE AF trial found rates of AF in patients who presumably had an atherosclerotic stroke were 10x higher following continuous monitoring with an insertable cardiac monitor (ICM) vs. those who did not receive continuous long-term monitoring (21.7% with an ICM vs. 2.4% in the control arm). This is an increase from the 1-year results which detected AF in 12.5% vs. 1.8% of patients, respectively, suggesting continuous and progressive detection of AF.

The clinical relevance of device-detected AF and the need for subsequent anticoagulation remains a key topic of interest. The STROKE AF trial found that 67% of patients in the continuous monitoring arm had clinically relevant AF lasting more than an hour in duration and anticoagulation was provided in up to 80% of patients in whom AF was detected. Of note, 88% of AF cases were asymptomatic suggesting that patient self-reporting of symptoms is an unreliable detection strategy.

These results suggest that there is a higher prevalence of AF than initially thought and provide rationale for a continuous monitoring strategy for patients following atherosclerotic stroke.

Written by Courtney Barker