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The following is a summary of “Factors associated with the detection of atrial fibrillation in patients with embolic stroke of undetermined source,” published in the January 2025 issue of Neurology by Bae et al. 

Detecting atrial fibrillation (AF) in embolic stroke of undetermined source (ESUS) is vital for secondary stroke prevention. 

Researchers conducted a retrospective study to identify factors linked to the detection of newly diagnosed AF in patients with ESUS. 

They included patients with ESUS with acute ischemic stroke. All underwent echocardiography and Holter monitoring. Structural and electrophysiological markers were examined, including left atrial enlargement (LAE) and non-sustained tachycardia (NSAT). An implantable loop recorder (ILR) was implanted in select patients. Sensitivity and positive predictive value analyses assessed AF detection. 

The results showed that among 312 patients with ESUS, AF was detected in 24 (7.7%) during follow-up. Patients with AF had a higher prevalence of LAE, NSAT, confluent, and additional lesions in a single vascular territory. Multivariable analysis identified ILR implantation (hazards ratio (HR) 11.497 [3.795–34.818]), LAE (3.204 [1.096–9.370]), NSAT (4.070 [1.378–12.018]), and confluent plus additional lesions (4.977 [1.649–15.019]) as independent predictors of AF detection. The sensitivity of AF detection in patients with LAE, NSAT, or confluent plus additional lesions was 91.7%. The positive predictive value was 40.0%. 

Investigators concluded that ILR monitoring effectively detected new AF in patients with LAE, NSAT, or confluent plus additional lesions. 

Source: bmcneurol.biomedcentral.com/articles/10.1186/s12883-024-04008-0