P-wave terminal force in lead V1 and atrial fibrillation burden in cryptogenic stroke with implantable loop recorders

Implantable loop recorders (ILRs) are useful for the detection of atrial fibrillation (AF) in patients with cryptogenic stroke (CS). P-wave terminal force in lead V 1 (PTFV 1 ) is associated with AF detection; however, data on the association between PTFV 1 and AF detection using ILRs in patients with CS are limited. Consecutive patients with CS with implanted ILRs from September 2016 to September 2020 at eight hospitals in Japan were studied. PTFV 1 was calculated by 12-lead ECG before ILRs implantation. An abnormal PTFV 1 was defined as ≥ 4.0 mV × ms. The AF burden was calculated as a proportion based on the duration of AF to the total monitoring period. The outcomes included AF detection and large AF burden, which was defined as ≥ 0.5% of the overall AF burden. Of 321 patients (median age, 71 years; male, 62%), AF was detected in 106 patients (33%) during the median follow-up period of 636 days (interquartile range [IQR], 436–860 days). The median time from ILRs implantation to AF detection was 73 days (IQR, 14–299 days). An abnormal PTFV 1 was independently associated with AF detection (adjusted hazard ratio, 1.71; 95% confidence interval [CI], 1.00 – 2.90). An abnormal PTFV 1 was also independently associated with a large AF burden (adjusted odds ratio, 4.70; 95% CI, 2.50–8.80). In patients with CS with implanted ILRs, an abnormal PTFV 1 is associated with both AF detection and a large AF burden. Clinical Trial Registration Information : UMIN Clinical Trials Registry 000044366.