Please use this identifier to cite or link to this item: https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.06.025
Title: Association between Bilateral Infarcts Pattern and Detection of Occult Atrial Fibrillation in Embolic Stroke of Undetermined Source (ESUS) Patients with Insertable Cardiac Monitor (ICM)
Authors: Yushan, Boi
Tan, Benjamin YQ
Ngiam, Nicholas Jinghao
Chan, Bernard PL
TEOH HOCK LUEN 
Vijay Kumar Sharma 
SIA CHING HUI 
Dalakoti, Mayank
SEOW SWEE CHONG 
KOJODJOJO PIPIN 
YEO LEONG LITT,LEONARD 
Keywords: Science & Technology
Life Sciences & Biomedicine
Neurosciences
Peripheral Vascular Disease
Neurosciences & Neurology
Cardiovascular System & Cardiology
Ischemic stroke
ESUS
cryptogenic
loop recorder
implantable
atrial fibrillation
ISCHEMIC-STROKE
Issue Date: 1-Sep-2019
Publisher: ELSEVIER
Citation: Yushan, Boi, Tan, Benjamin YQ, Ngiam, Nicholas Jinghao, Chan, Bernard PL, TEOH HOCK LUEN, Vijay Kumar Sharma, SIA CHING HUI, Dalakoti, Mayank, SEOW SWEE CHONG, KOJODJOJO PIPIN, YEO LEONG LITT,LEONARD (2019-09-01). Association between Bilateral Infarcts Pattern and Detection of Occult Atrial Fibrillation in Embolic Stroke of Undetermined Source (ESUS) Patients with Insertable Cardiac Monitor (ICM). JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 28 (9) : 2448-2452. ScholarBank@NUS Repository. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.06.025
Abstract: © 2019 Elsevier Inc. Background and Aims: Increasingly, insertable cardiac monitors (ICM) have been used to detect Atrial Fibrillation (AF) in patients with cryptogenic stroke or embolic strokes of undetermined source (ESUS). We aim to examine the characteristics of these patients who were subsequently found to have AF. Methods: We studied 83 consecutive patients who were comprehensively evaluated using neuroimaging and vessel imaging (computed tomography angiography, magnetic resonance angiography, or transcranial and extracranial Doppler sonography) to have met the previously established ESUS criteria. All 83 patients had ICM implanted between 2015 and 2017. All patients were followed up for at least 1 year, with a median follow-up period of 1.5 ± .5 years. We compared the baseline clinical, laboratory, echocardiographic, neuro-imaging profiles, and clinical outcomes in terms of functional recovery, recurrent stroke, and mortality in patients with and without detected AF. Results: AF detection rate in this ESUS cohort was 12% over the study period. Patients with detected AF were associated with bilateral infarcts pattern at presentation (30% versus 5.5%, P = .035). Infarcts involving multiple vascular territories was not significantly associated with the detection of AF. There were no significant differences in the other clinical characteristics and outcomes between the AF group compared to the group without detected AF. Echocardiographic parameters including left ventricular ejection fraction and left atrial diameter were also not shown to be significantly different. Conclusion: Our study found that a neuroimaging profile of bilateral infarcts was associated with AF detection using insertable cardiac monitor in ESUS patients. Larger prospective studies are needed to validate our findings.
Source Title: JOURNAL OF STROKE & CEREBROVASCULAR DISEASES
URI: https://scholarbank.nus.edu.sg/handle/10635/162208
ISSN: 1052-3057
1532-8511
DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.025
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