Abstract

Introduction Current literature suggests that up to 30% of cryptogenic strokes (CS) have subsequent detection of atrial fibrillation (AF), dependent on duration of ambulatory cardiac monitoring. Several scoring systems have been developed to identify those patients at increased risk of incident AF, with variable sensitivity and specificity. We aimed to characterise clinical demographics and comorbidities associated with the development of AF in CS patients. Methods Following PRISMA guidelines, a comprehensive search of medical databases and grey literature was conducted to identify pertinent studies analysing the incidence of AF following CS, from January 2000 to August 2023 (figure 1). Individual factors were extracted and subjected to meta-analysis. A random effects model was employed to establish an overall effect size through standardised mean difference (SMD) or odds ratio (OR). Results We included data from 96 studies with a total of 29318 patients. Notable associations with AF development post-CS included CHA2DS2VASC ≥ 4 (OR 2.07; 95% CI 1.48 to 2.90, p<0.001), age ≥ 75 (OR 3.52; 95% CI, 2.78 to 4.47, p<0.001), left atrial enlargement (OR 2.09, 95% CI 1.58 to 2.75, p<0.001) and presence of valvular heart disease (OR 2.11, 95% CI, 1.04 to 4.26, p = 0.038). Of note, obesity, diabetes mellitus, and a history of heart failure were not associated with AF development. See table 1. Conclusion This systematic review identifies clinical and echocardiographic factors associated with incident AF post-CS; use of such factors in predictive algorithms may be useful in identification of patients who may benefit from prolonged cardiac monitoring in this population. Conflict of Interest N/A