Pathophysiological mechanisms involved in the new onset of AF after stroke: Preliminary results from SAFAS study (Stepwise screening for silent Atrial Fibrillation After Stroke)

Abstract

Introduction One third of cryptogenic strokes are believed to be secondary to silent atrial fibrillation (AF) not detected by standard cardiac monitoring methods. The aim of our study was to identify physiopathological dysregulations leading to the development of AF. Starting from the hypothesis of P. Coumel we approached the 3 factors involved in the arrhythmia development (the atrial substrate, the modulators, the triggers). Methods We included all consecutive patients hospitalized for ischemic stroke in the Dijon stroke unit, between March and November 2018, of undetermined etiology at the admission. Screening for AF was performed with a sequential and uninterrupted method associating telemetry in the stroke unit, followed by prolonged Holter-electrocardiogram (ECG) (SpiderFlash, Microport) during the entire period of hospitalization in the conventional sector and insertable cardiac monitor (ICM) (REVEAL, Medtronic) at discharge if necessary. We compared clinical, echocardiographic, rhythmic and biological data and biomarkers between patients with sinus rhythm and those developing AF. Multivariate logistic regression analyzes were performed to determine AF predictors. Results Among the 100 patients analyzed, 38 patients (38%) developed AF. The prolonged Holter-ECG detected 24% of AF and 89% of these occurred after the conventional 24-hour monitoring. The ICM detected 18% of AF occurring in a mean delay of 130 days after stroke. The model associating NTpro-BNP ≥\xa0295\xa0pg/ml, osteoprotegerin\xa0≥\xa01075\xa0pg/ml (marker of inflammation) and pNN50 (parasympathetic tone) on the first day of the telemetry provided excellent prediction of the AF occurrence (AUC 0.83, P\xa0 Conclusion Our model representing the 3 factors associated with the arrhythmias provided excellent prediction of AF. The AF screening method\xa0was optimal and new, by a sequential, prolonged, early and uninterrupted monitoring improving its detection while limiting the implantation of ICM.