Identifying patients at low risk for atrial fibrillation after cryptogenic stroke: the PAVA score
Abstract
AIMS: Continuous cardiac monitoring with implantable loop recorders (ILRs) is recommended after cryptogenic stroke to detect occult atrial fibrillation (AF). We aimed to develop and validate a dedicated risk score for AF detection in patients undergoing ILR monitoring after cryptogenic stroke. METHODS AND RESULTS: This multicentre study enrolled 1002 consecutive patients (mean age 66.0 ± 12.3 years, 57.9% male) who received an ILR after cryptogenic stroke. The primary outcome was a first episode of AF or atrial tachycardia (AT). A score was developed in a randomly split development cohort and validated internally, accounting for competing risks, missing data imputation, and hazard ratio-based weighting. Among the 668 patients in the development cohort, cumulative incidences of AF/AT at 1, 2, and 3 years were 20.3%, 28.9%, and 33.0%, respectively. Four independent predictors were identified: premature atrial contractions > 200/24 h on Holter-ECG (2 points), age >58-78 years (3 points) or > 78 years (4 points), significant valvular heart disease (1 point), and left atrial dilatation (2 points), forming the PAVA (premature atrial contractions, age, significant valvular heart disease, and left atrial dilatation) score. Discrimination was good in both the development and validation cohorts (c-index 0.73 and 0.79, respectively). The 3-year areas under the curve were 0.800 and 0.905, respectively. A PAVA score ≤ 2, observed in 23.6% of patients, yielded negative predictive values of 89.2% and 100% in the development and validation cohorts. ROC-curve analysis confirmed superior clinical utility over existing scores (Brown ESUS-AF [Brown embolic stroke of undetermined source-atrial fibrillation], HAVOC). CONCLUSION: A PAVA score ≤ 2 demonstrates a high negative predictive value for AF/AT on ILR after cryptogenic stroke, offering a practical tool to optimize patient prioritization for ILR implantation.
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BibTeX
@article{maille2026identifying,
title = {{Identifying patients at low risk for atrial fibrillation after cryptogenic stroke: the PAVA score}},
author = {Baptiste Maille and Noémie Resseguier and Eloi Marijon and Nathalie Behar and Marc Badoz and Fabrice Vuillier and Cecile Malrain and Claire Grygorowicz and Victor Klein and Aymeric Menet and Maryam Dridi and Christelle Haddad and David Calvet and Laurent Suissa and Luciano Sposato and Jean-Claude Deharo and Yannick Bejot and Charles Guenancia},
journal = {EP-Europace},
year = {2026},
month = sep,
doi = {10.1093/europace/euag183},
url = {https://hal.science/hal-05793242v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Identifying patients at low risk for atrial fibrillation after cryptogenic stroke: the PAVA score
AU - Baptiste Maille
AU - Noémie Resseguier
AU - Eloi Marijon
AU - Nathalie Behar
AU - Marc Badoz
AU - Fabrice Vuillier
AU - Cecile Malrain
AU - Claire Grygorowicz
AU - Victor Klein
AU - Aymeric Menet
AU - Maryam Dridi
AU - Christelle Haddad
AU - David Calvet
AU - Laurent Suissa
AU - Luciano Sposato
AU - Jean-Claude Deharo
AU - Yannick Bejot
AU - Charles Guenancia
PY - 2026
DA - 2026/09/02
JO - EP-Europace
DO - 10.1093/europace/euag183
UR - https://hal.science/hal-05793242v1
AB - AIMS: Continuous cardiac monitoring with implantable loop recorders (ILRs) is recommended after cryptogenic stroke to detect occult atrial fibrillation (AF). We aimed to develop and validate a dedicated risk score for AF detection in patients undergoing ILR monitoring after cryptogenic stroke. METHODS AND RESULTS: This multicentre study enrolled 1002 consecutive patients (mean age 66.0 ± 12.3 years, 57.9% male) who received an ILR after cryptogenic stroke. The primary outcome was a first episode of AF or atrial tachycardia (AT). A score was developed in a randomly split development cohort and validated internally, accounting for competing risks, missing data imputation, and hazard ratio-based weighting. Among the 668 patients in the development cohort, cumulative incidences of AF/AT at 1, 2, and 3 years were 20.3%, 28.9%, and 33.0%, respectively. Four independent predictors were identified: premature atrial contractions > 200/24 h on Holter-ECG (2 points), age >58-78 years (3 points) or > 78 years (4 points), significant valvular heart disease (1 point), and left atrial dilatation (2 points), forming the PAVA (premature atrial contractions, age, significant valvular heart disease, and left atrial dilatation) score. Discrimination was good in both the development and validation cohorts (c-index 0.73 and 0.79, respectively). The 3-year areas under the curve were 0.800 and 0.905, respectively. A PAVA score ≤ 2, observed in 23.6% of patients, yielded negative predictive values of 89.2% and 100% in the development and validation cohorts. ROC-curve analysis confirmed superior clinical utility over existing scores (Brown ESUS-AF [Brown embolic stroke of undetermined source-atrial fibrillation], HAVOC). CONCLUSION: A PAVA score ≤ 2 demonstrates a high negative predictive value for AF/AT on ILR after cryptogenic stroke, offering a practical tool to optimize patient prioritization for ILR implantation.
SN - 1099-5129
SN - 1532-2092
ER -