Predictors for atrial fibrillation detection after cryptogenic stroke: Results from CRYSTAL AF.

Objective: We assessed predictors of atrial fibrillation (AF) in cryptogenic stroke (CS) or transient ischemic attack (TIA) patients who received an insertable cardiac monitor (ICM). Methods: We studied patients with CS/TIA who were randomized to ICM within the CRYSTAL AF study. We assessed whether age, sex, race, body mass index, type and severity of index ischemic event, CHADS 2 score, PR interval, and presence of diabetes, hypertension, congestive heart failure, or patent foramen ovale and premature atrial contractions predicted AF development within the initial 12 and 36 months of follow-up using Cox proportional hazards models. Results: Among 221 patients randomized to ICM (age 61.6 ± 11.4 years, 64% male), AF episodes were detected in 29 patients within 12 months and 42 patients at 36 months. Significant univariate predictors of AF at 12 months included age (hazard ratio [HR] per decade 2.0 [95% confidence interval 1.4–2.8], p = 0.002), CHADS 2 score (HR 1.9 per one point [1.3–2.8], p = 0.008), PR interval (HR 1.3 per 10 milliseconds [1.2–1.4], p 123 vs 0 [1.3–12.0], p = 0.009 across quartiles), and diabetes (HR 2.3 [1.0–5.2], p p = 0.0009) and PR interval (HR 1.3 [1.2–1.4], p Conclusion: Increasing age and a prolonged PR interval at enrollment were independently associated with an increased AF incidence in CS patients. However, they offered only moderate predictive ability in determining which CS patients had AF detected by the ICM.