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Research Article: Characteristics of patients with cryptogenic stroke and atrial fibrillation detected using insertable cardiac monitoring in the chronic phase: a subanalysis of the LOOK study

Date Published: 2026-05-15

Abstract:
Occult atrial fibrillation (AF) is a major underlying cause of cryptogenic stroke (CS) and is frequently identified only after hospital discharge. However, the characteristics of late-detected AF remain unclear. In this study, we aimed to investigate the clinical characteristics of patients with late-detected AF identified >30?days after the onset of stroke, compared with those without AF detection. Data from patients with CS who underwent implantation of an insertable cardiac monitor in the multicenter LOOK study were analyzed. Patients were categorized into three groups. Early-detected (within 30?days), Late-detected (after 30?days), and No-detected AF. Clinical characteristics were primarily compared between the Late-detected and No-detected AF groups, with additional exploratory comparisons involving the Early-detected AF group. AF was detected in 42 (32.8%) of the 128 patients (median age, 71?years; 68.0% male). Eight patients were classified into the Early-detected AF group, 34 into the Late-detected AF group, and 86 into the No-detected AF group. Compared with the no-detected AF group, patients in the late-detected AF group were older (78 vs. 66?years, p <?0.001) and had lower hyperlipidemia rates (17.6% vs. 39.5%, p =?0.03), but higher rates of large-vessel occlusion (26.5% vs. 10.5%, p =?0.01) and D-dimer levels (1.1 vs. 0.7??g/mL, p =?0.04). The modified Rankin Scale score before insertable cardiac monitor implantation tended to be lower in the late-detected AF group than in the early-detected AF group ( p =?0.05). Patients with CS and late-detected AF, compared with those without AF detection, were older, had fewer atherosclerotic risk factors, and more frequently had large-vessel occlusion. These findings highlight the importance of long-term rhythm monitoring after stroke in patients at higher risk of late-detected AF.

Introduction:
Occult atrial fibrillation (AF) is a major underlying cause of cryptogenic stroke (CS) and is frequently identified only after hospital discharge. However, the characteristics of late-detected AF remain unclear. In this study, we aimed to investigate the clinical characteristics of patients with late-detected AF identified >30?days after the onset of stroke, compared with those without AF detection.

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