Atrial Fibrillation In Patients With Stroke Attributed to Large- or Small-Vessel Disease
Authors: Bernstein Richard A. , Kamel Hooman , Granger Christopher B. , Piccini Jonathan P. , Katz Jeffrey M. , Sethi Pramod P. , Pouliot Erika , Franco Noreli , Ziegler Paul D. , Schwamm Lee H. ,   STROKE AF Investigators, Acosta Indrani , Jamnadas Pradipkumar , Manda Sushma , Alimohammad Rizwan , Arias Valerie , Tempro Kristi , Ward Kathleen , Asi Khaled , Choudhuri Indrajit , Guerrero Waldo , Kalia Junaid , Niazi Imran , Sajjad Rehan , Thavapalan Varoon , Assar Manish , Banchs Javier , Black James , Cheung Peter , Donsky Alan , Graybeal Dion , Hasan Rashedul , Mir Osman , Nguyen Claude , Olsovsky Gregory , Rasmussen Jennifer , Hasabnis Sanjeev , Reeves Russell , Rowley Chris , Sharma Jitendra , Smith Macey , Bonyak Kay , Sackett Matthew , Allred James , Sethi Pramod , Jung Richard , Lynch Jennifer , Rowe Steven , Dash Subasini , Glotzer Taya , Jamal Sameer , Radoslovich Glauco , Shukla Gunjan , Zimmerman John , Hussein Haitham , Zhu Dennis , Krueger Kristopher , Ostrander Matthew , Ramirez Darwin , Shultz Jeffrey , Simonson Jay , Cucchiara Brett , Deo Rajat , Frankel David , Jia Judy , Kasner Scott , Luciano Jeanie , Messe Steven , Mullen Michael , Santangeli Pasquale , Schaller Robert , Yuan Qingyang , Bledsoe Don , Cajavilca Christian , Chiu David , Gadhia Rajan , Grimes Maranda Randi , Katz Larry , Moye Stacy , Rami Tapan , Thomas Abraham , Volpi John , Al Balushi Ali , Boyd Clara , Choudry Subbarao , Dhamoon Mandip , Dukkipati Srinivas , Goltz Davida , Hao Qing , Horowitz Deborah , Kaur Gurmeen , Koruth Jacob , Kurian Christeena , Langan Marie-Noelle , Matos Diaz Ivan , Miller Marc , Reddy Vivek , Sheinart Kara , Stein Laura , Tansy Aaron , Tuhrim Stanley , Weinberger Jesse , Whang William , Cross Jonathan , Kreger Howard , Saltzman Marc , Zide Kenneth , Bansal Sandeep , Bernabei Matthew , Flaster Murray , Barrett Conor , Etherton Mark , Heist E. Kevin , Lubitz Steven , Regenhardt Robert , Sharma Richa , Silverman Scott , Sloane Kelly , Viswanathan Anand , Doshi Amit , Logan William , Malik Maheen , Rempe David , Arora Rohan , Beldner Stuart , Epstein Laurence , Ismail Haisam , Jadonath Ram , Katz Jeffrey , Libman Richard , Moussavi Mohammad , Patel Anand , Patel Apoor , Willner Jonathan , Wright Paul , Caprio Frances , Kim Susan , Mendelson Scott , Passman Rod , Ruff Ilana , Alsorogi Mohammad , Chaudhary Gauhar , Morris Kent , Mullins Savannah , Talpur Nadeem , Thomas Kevin , Chancellor Breehan , Chinitz Larry , Culpepper Andre , Fara Michael , Ishida Koto , Lillemoe Kaitlyn , Lord Aaron , Torres Jose , Zhang Cen , Abi-Samra Freddy , Bernard Michael , Carter Jacqueline , Chokhawala Himanshu , Downey Amanda , Khatib Samuel , Morin Daniel , Polin Glenn , Rogers Paul , Vidal Gabriel , Zweifler Richard , Belt Gary , Felberg Robert , Furer Steve , Hanna John , McCall-Brown Angela , Seeger Susan , Reddy Ramakota , Skalabrin Elaine , Soik Diane , Wilder Michael , Kearney Michelle , LaFranchise Eugene , Parker Brett , Pickett Robert Andrew (Drew) , Bonaguidi Heather , Gibson Douglas , Kalafut Mary , Mattera Beth , Olson Nicholas , Parker Mary , Rogers John , Uddin Poulina , Chang Cherylee , Graner Sarah , Kipta Joseph , Salem Rony , Singh David , Al-Awwad Ahmad , Beaver Bahar , Chaudhary Shuchi , Clayton Stephen , Delpirou Nouh Claire , Garabelli Paul , Gordon David , Pakala Aneesh , Ray Bappaditya , Saucedo Scott , Sidorov Evgeny , Stavrakis Stavros , Ching Marilou , Deline Christopher , Hourihane J. Maurice , Kandel Amit , Kim Chee , Magun Rakesh , Mowla Ashkan , Sawyer Robert , Switzer Donald , Badhwar Nitish , Lee Randall , Meisel Karl , Smith Wade , Alkahalifah Moayd , Aroor Sushanth , Asdaghi Negar , Bhatt Nirav , Del Brutto Victor , Dillon George , Gadient Paul , Koch Sebastian , Lambrakos Litsa , Malik Amer , Marulanda-Londono Erika , Memon Zeeshan , Mendoza Ivan , Mitrani Raul , Ortiz Gustavo , Ramano Jose , Sur Nicole , Torres Luis , Daniels James , Johnson Mark , Magadan Alejandro , Shang Ty , Mcclelland Nancy , Merriam Theodore , Neisen Karah 
Published: October 2023

Importance

The STROKE AF study found that in patients with prior ischemic stroke attributed to large-artery atherosclerotic disease (LAD) or small-vessel occlusive disease (SVD), 12% developed AF over 1 year when monitored with an insertable cardiac monitor (ICM). The occurrence over subsequent years is unknown.

Objectives

To compare the rates of AF detection through 3 years of follow-up between an ICM vs site-specific usual care in patients with prior ischemic stroke attributed to LAD or SVD.

Design, Setting, and Participants

This multicenter, randomized (1:1) clinical trial took place at 33 sites in the US with enrollment between April 2016 and July 2019 and 3-year follow-up through July 2022. Eligible patients were aged 60 years or older, or aged 50 to 59 years with at least 1 additional stroke risk factor and had an index ischemic stroke attributed to LAD or SVD within 10 days prior to ICM insertion. Of the 496 patients enrolled, 492 were randomized and 4 were excluded.

Interventions

ICM monitoring vs site-specific usual care.

Main Outcomes and Measures

The prespecified long-term outcome of the trial was AF detection through study follow-up (up to 3 years). AF was defined as an episode lasting more than 30 seconds, adjudicated by an expert committee.

Results

In total, 492 patients were randomized and included in the analyses (median [IQR] age, 66 [60-74] years; 307 men [62.4%] and 185 women [37.6%]), of whom 314 completed 3-year follow-up (63.8%). The incidence rate of AF at 3 years was 21.7% (46 patients) in the ICM group vs 2.4% (5 patients) in the control group (hazard ratio, 10.0; 95% CI, 4.0-25.2; P &amp;lt; .001).

Conclusions and Relevance

Patients with ischemic stroke attributed to LAD or SVD face an increasing risk of AF over time and most of the AF occurrences are not reliably detected by standard medical monitoring methods. One year of negative monitoring should not reassure clinicians that patients who have experienced stroke will not develop AF over the next 2 years.

Trial Registration

ClinicalTrials.gov Identifier: NCT02700945