Predictive Value of Newly Detected Atrial Fibrillation Paroxysms in Patients With Acute Ischemic Stroke, for Atrial Fibrillation After 90 Days

Background and Purpose—Extended cardiac monitoring immediately after acute ischemic stroke (AIS) increases paroxysmal atrial fibrillation (PAF) detection, but its reliability for detection or exclusion of longer term paroxysmal PAF is unknown. We evaluated the positive and negative predictive value (PPV and NPV) of AF detection early after AIS, for PAF confirmation 90 days later. Methods—We investigated 49 patients within 7 days of AIS for PAF according to current guidelines; 23 patients received 7 days of additional noninvasive cardiac event monitoring with an R-test device early after their stroke (ISRCTN 97412358). Ninety days after AIS, everyone underwent 7 days of cardiac event monitoring. We calculated the PPV and NPV of immediate PAF detection through extended cardiac event monitoring and through any investigative modality, for the presence of PAF on the 90-day event monitor. Results—PAF detected by a 7-day event monitor within 2 weeks of AIS had a PPV of 100% (95% confidence interval, 72%–100%) fo...