Abstract Details

Title Predicting Afib in Cryptogenic Ischemic Stroke Patients with Implantable Loop Recorders

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 127

Objective

To create a scoring system for cryptogenic ischemic stroke patients with an implantable loop recorder (ILR) that reflects the likelihood of paroxysmal atrial fibrillation (Afib) detection.

Background Afib detection in cryptogenic stroke is difficult but essential because management changes. We describe a scoring system that discriminates between cryptogenic ischemic stroke patients with ILR that were and were not found to have Afib.

Design/Methods Consecutive cryptogenic stroke cases from cardiology’s ILR registry for a 2-year period (7/2017-7/2019) were reviewed. We used standardized case report forms to perform chart abstraction. Cases were excluded if ILR was not placed after the index stroke event, stroke etiology workup was not available, or data was incomplete. Patients found to have Afib on ILR were compared to those without evidence of Afib on ILR. We devised a novel scoring system using variables associated with Afib detection and compared its ability to classify Afib detection against CHA2DS2-VASc and LADS.

Results One hundred fifty-seven patients met inclusion criteria. Afib was detected in 12% of cases (9% at 6 months, 10% at 12 months). The median time from ILR placement to Afib detection was 110 days (IQR 37, 507). Median time from Afib detection to the start of anticoagulation was 3 days (IQR 0, 8). The PAL-CrISP score ranges 0 to 7: age (70=0, ≥70=4), history of antihypertensive medication (no=0, yes=2), PR interval (≤200msec=0, >200msec=1). Of those found to have Afib via ILR, 74% (14/19) had a PAL-CrISP score ≥ 6. In cryptogenic stroke patients with ILR, PAL-CrISP performed better at predicting Afib detection (AUC 0.810, 95% CI 0.706-0.913) than CHA2DS2-VASc (AUC 0.650, 95% CI 0.525-0.774) and LADS (AUC 0.745, 95% CI 0.624-0.866).

Conclusions

The novel PAL-CrISP score performs better than CHA2DS-VASc and LADS at predicting Afib detection via ILR in cryptogenic stroke and uses only age, home medications, and an EKG.

Authors/Disclosures
Claribel D. Wee, MD (SUNY Upstate Medical University) PRESENTER	Dr. Wee has nothing to disclose.
Tejeswi Suryadevara, MD	Ms. Suryadevara has nothing to disclose.
Husitha Reddy Vanguru, MBBS	Dr. Vanguru has nothing to disclose.
Rashid A. Ahmed, MD (Upstate University Hospital)	Dr. Ahmed has nothing to disclose.
	No disclosure on file
Stephanie Loveless, NP (SUNY Upstate Medical University)	Mrs. Loveless has nothing to disclose.
	No disclosure on file
Julius Latorre, MD, F�鶹��ýӳ�� (SUNY Upstate Med Univ Hosp/Neuro)	Dr. Latorre has nothing to disclose.
Karen C. Albright, DO, DO, PhD, MS, MPH (FDA)	Dr. Albright has nothing to disclose.

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