Background and Aims

Atrial Fibrillation is the most important cause of ESUS. Implantable Loop Recorder demonstrated the highest sensitivity for detecting it.

This register was created to confirm the high prevalence of AF in patients after ESUS and to verify possible benefits on clinical outcomes such as TIA/stroke recurrence and death using ILR.

Methods

278 patients admitted to “Molinette” Hospital in Stroke Unit department between 2011 and 2019, diagnosed with ESUS, underwent ILR implantation if they had at least one risk factor for AF.

165 patients admitted in other departments in the same center for the same pathology, without ILR rapresented the control group.

We used propensity score to select 132 patients from each group (matching age, sex, CHADS-VASC, and HAS-BLEED baseline characteristics).

Risk and protective factors were estimated for clinical outcomes (deaths and TIA/stroke recurrence) and were evaluated with logistic regression univariate/multivariate analysis.

Results

The detection rate of AF episodes was significantly higher in the ILR group (41.7% vs 15.9%, p<0.001)

On univariate analysis, we didn't find a significant association between ILR and clinical outcomes, although a relevant protective trend for TIA/stroke recurrence and mortality has been pointed out (p=0.06).

On multivariate analysis, we detected a protective role of ILR in terms of TIA/stroke recurrence.

Conclusions

With our statistical models we identified for the first time in a real-world population a significant clinical benefit from ILR monitoring, evidenced by a trend of less death and TIA/stroke recurrence in univariate analysis and relevant ILR protection in multivariate models for prediction of TIA/stroke recurrence