Paroxysmal atrial fibrillation and flutter (PAF) was detected with high prevalence following early post-cryptogenic stroke implantable loop recorder (ILR) implantation and resulted in significant management changes, a recent study found. Older age, increased PR interval, left atrial (LA) enlargement, and lower HbA1c are significantly associated with PAF detection. A retrospective study was conducted of cryptogenic ischemic stroke (CIS) patients (n=100, mean age 65.8 years; 52.5% female) who underwent ILR insertion during, or soon after, index stroke admission. Patients were prospectively followed by the study’s cardiac electrophysiologist who confirmed the PAF diagnosis. They found:

• PAF was detected in 31 of 100 (31%) CIS patients, and anticoagulation was initiated in almost all (30 of 31, 96.8%).
• Factors associated with PAF detection include older age (mean [year] 72.9 vs 62.9), white race, prolonged PR interval, larger LA diameter and LA volume index, and lower hemoglobin HbA1c.
• Controlling for age and obesity was independently associated with PAF detection.