Atrial Fibrillation Detection in ESUS patients
All 307 patients with ESUS were given a prescription for CEM. Out of the
307 patients, 155 completed the monitoring process successfully. The
rest either declined or were unable to complete the process. Of the 155
patients who completed monitoring, 88 only had a 30-day CEM and 67 also
had successful ILR in addition to the CEM, while the rest either
declined or were lost to follow-up. Among all 307 ESUS patients, AF was
detected in 32 patients who received scheduled cardiac monitoring.
Additionally, 7 patients who did not receive scheduled cardiac
monitoring were incidentally found to have AF in subsequent outpatient
or hospital visits. Patients with AF detected had significantly
decreased mean LA reservoir strain (25.15±13.57 vs. 32.95±16.20, p =
0.005), LA contractile strain (12.24±10.00 vs. 15.95±9.41, p = 0.023),
and LA conduit strain (12.91±6.45 vs. 17.00±11.09, p = 0.025) compared
to patients without AF detected (Table 3). In the sensitivity analysis
using the 32 ESUS patients found to have AF on cardiac monitoring, there
was no significant difference in LA reservoir strain (26.15+ 15.25
vs. 26.50+ 12.17, p = 0.953), LA contractile strain
(12.79+ 11.90 vs. 11.56+ 6.74, p = 0.785), and LA conduit
strain (13.36 + 6.31 vs. 14.94+ 7.12, p = 0.557) between
those with an AF burden of less than 24 hours compared to those with an
AF burden of greater than or equal to 24 hours likely due to small
sample size (Table 4). In the sensitivity analysis using only the 155
ESUS patients who received cardiac monitoring, the effect size of LA
strain remained stable, but significance was also lost likely due to
small sample size (Supplementary Table 1).