Atrial fibrillation in cryptogenic stroke and TIA patients in The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study: Main results

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  • B. Ratajczak-Tretel
  • A. Tancin Lambert
  • R. Al-Ani
  • K. Arntzen
  • G. K. Bakkejord
  • H. M. O. Bekkeseth
  • V. Bjerkeli
  • G. Eldøen
  • A. Gulsvik
  • B. Halvorsen
  • G. A. Høie
  • H. Ihle-Hansen
  • H. Ihle-Hansen
  • H. Ihle-Hansen
  • S. Ingebrigtsen
  • H. Johansen
  • C. Kremer
  • S. B. Krogseth
  • M. Kurz
  • I. Nakstad
  • V. Novotny
  • H. Næss
  • R. Qazi
  • M. K. Rezaj
  • D. M. Rørholt
  • L. H. Steffensen
  • J. Sømark
  • H. Tobro
  • L. Wassvik
  • K. L. Ægidius
  • D. Atar
  • A. H. Aamodt

Introduction: Secondary stroke prevention depends on proper identification of the underlying etiology and initiation of optimal treatment after the index event. The aim of the NOR-FIB study was to detect and quantify underlying atrial fibrillation (AF) in patients with cryptogenic stroke (CS) or transient ischaemic attack (TIA) using insertable cardiac monitor (ICM), to optimise secondary prevention, and to test the feasibility of ICM usage for stroke physicians. Patients and methods: Prospective observational international multicenter real-life study of CS and TIA patients monitored for 12 months with ICM (Reveal LINQ) for AF detection. Results: ICM insertion was performed in 91.5% by stroke physicians, within median 9 days after index event. Paroxysmal AF was diagnosed in 74 out of 259 patients (28.6%), detected early after ICM insertion (mean 48 ± 52 days) in 86.5% of patients. AF patients were older (72.6 vs 62.2; p < 0.001), had higher pre-stroke CHA₂DS₂-VASc score (median 3 vs 2; p < 0.001) and admission NIHSS (median 2 vs 1; p = 0.001); and more often hypertension (p = 0.045) and dyslipidaemia (p = 0.005) than non-AF patients. The arrhythmia was recurrent in 91.9% and asymptomatic in 93.2%. At 12-month follow-up anticoagulants usage was 97.3%. Discussion and conclusions: ICM was an effective tool for diagnosing underlying AF, capturing AF in 29% of the CS and TIA patients. AF was asymptomatic in most cases and would mainly have gone undiagnosed without ICM. The insertion and use of ICM was feasible for stroke physicians in stroke units.

TidsskriftEuropean Stroke Journal
Udgave nummer1
Sider (fra-til)148-156
Antal sider9
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: investigator driven academic study, supported by Oslo University Hospital, Norwegian Health Association, South-Eastern Norway Regional Health Authority, Østfold Hospital Trust and the European Cerebrovascular Research Infrastructure (ECRI). Devices were partly made available by Medtronic. BRT and ATL are recipients of PhD grants from the South-Eastern Norway Regional Health Authority.

Funding Information:
BRT and ATL have received travel funding from Medtronic.

Publisher Copyright:
© The Author(s) 2022.

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