Peer-reviewedCC BY-NC-NDHeart rhythm O26 Jul 2026

Atrial fibrillation detection using an implantable loop recorder after cryptogenic stroke.

Evan C Adelstein¹
Deborah F Steinberg²
David A Steckman³
Alfred M Loka¹

¹Department of Medicine, Division of Cardiology, Albany Medical College, Albany, New York.
²Department of Neurology, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania.
³Nuvance Health Heart and Vascular Institute, Poughkeepsie, New York.

Abstract

Background

Implantable loop recorders (ILRs) assist in detecting occult atrial fibrillation (AF) in patients with cryptogenic stroke (CS), yet many patients do not manifest subsequent AF.Objective

To identify factors associated with ILR-detected AF, thereby improving device specificity.Methods

All 744 patients implanted with ILRs at our Stroke Center from 2014 to 2025 after ischemic CS were followed for AF episodes of ≥6 minutes and recurrent stroke.Results

During 657 ± 450 (median 591) days, 138 (18.5%) patients manifested AF lasting ≥6 minutes, with the highest risk within the first 6 months. Older age (hazard ratio [HR], 1.05 per year; 95% confidence interval [CI], 1.03-1.07; P < .001), tricuspid regurgitation (HR, 1.61; 95% CI, 1.10-2.35; P = .015), and middle cerebral artery stroke (HR, 1.79; 95% CI, 1.18-2.71; P = .006) were independently associated with shorter time to initial AF. Multivessel strokes were not associated with AF detection. In the oldest age quartile (≥76), 28% manifested AF. Mitral regurgitation, tricuspid regurgitation, and β-blocker use were associated with shorter time to initial AF. In the middle 2 age quartiles (57-75), 18% had detected AF. Middle cerebral artery stroke was independently associated with AF risk. Only 6% in the youngest age quartile (≤56) manifested AF. Of 44 patients with recurrent stroke, 6 had detected AF. Stroke was temporally related to AF in 2 patients.Conclusion

Older age is highly associated with subsequent AF detection in CS. Mitral and tricuspid regurgitation and middle cerebral artery strokes are associated with AF in older and middle-aged patients, respectively. Recurrent stroke was rarely associated with temporally related AF.

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Cite

BibTeX RIS

BibTeX

@article{adelstein2026atrial,
  title = {{Atrial fibrillation detection using an implantable loop recorder after cryptogenic stroke.}},
  author = {Evan C Adelstein and Deborah F Steinberg and David A Steckman and Alfred M Loka},
  journal = {Heart rhythm O2},
  year = {2026},
  month = jul,
  doi = {10.1016/j.hroo.2026.06.025},
  url = {https://europepmc.org/article/MED/42936027},
  note = {CC BY-NC-ND},
}

RIS

TY  - JOUR
TI  - Atrial fibrillation detection using an implantable loop recorder after cryptogenic stroke.
AU  - Evan C Adelstein
AU  - Deborah F Steinberg
AU  - David A Steckman
AU  - Alfred M Loka
PY  - 2026
DA  - 2026/07/06
JO  - Heart rhythm O2
DO  - 10.1016/j.hroo.2026.06.025
UR  - https://europepmc.org/article/MED/42936027
AB  - Background  Implantable loop recorders (ILRs) assist in detecting occult atrial fibrillation (AF) in patients with cryptogenic stroke (CS), yet many patients do not manifest subsequent AF.Objective  To identify factors associated with ILR-detected AF, thereby improving device specificity.Methods  All 744 patients implanted with ILRs at our Stroke Center from 2014 to 2025 after ischemic CS were followed for AF episodes of ≥6 minutes and recurrent stroke.Results  During 657 ± 450 (median 591) days, 138 (18.5%) patients manifested AF lasting ≥6 minutes, with the highest risk within the first 6 months. Older age (hazard ratio [HR], 1.05 per year; 95% confidence interval [CI], 1.03-1.07; P < .001), tricuspid regurgitation (HR, 1.61; 95% CI, 1.10-2.35; P = .015), and middle cerebral artery stroke (HR, 1.79; 95% CI, 1.18-2.71; P = .006) were independently associated with shorter time to initial AF. Multivessel strokes were not associated with AF detection. In the oldest age quartile (≥76), 28% manifested AF. Mitral regurgitation, tricuspid regurgitation, and β-blocker use were associated with shorter time to initial AF. In the middle 2 age quartiles (57-75), 18% had detected AF. Middle cerebral artery stroke was independently associated with AF risk. Only 6% in the youngest age quartile (≤56) manifested AF. Of 44 patients with recurrent stroke, 6 had detected AF. Stroke was temporally related to AF in 2 patients.Conclusion  Older age is highly associated with subsequent AF detection in CS. Mitral and tricuspid regurgitation and middle cerebral artery strokes are associated with AF in older and middle-aged patients, respectively. Recurrent stroke was rarely associated with temporally related AF.
SN  - 2666-5018
ER  -

Abstract

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