Can insertable cardiac monitoring improve detection of atrial fibrillation in women with cryptogenic stroke? A comparative cohort study, published in Europace, assessed the association of insertable cardiac monitoring (ICM) versus standard non-invasive follow-up with atrial fibrillation (AF) detection and clinical outcomes in women with cryptogenic stroke.

The analysis included 475 women (mean age 73 ± 12 years), of whom 262 underwent ICM. All participants had complete data in the Norwegian Stroke Registry. Primary outcomes were AF detection and recurrent stroke at 1 and 2 years. Secondary outcomes included mortality, composite stroke and mortality, ischaemic cardiovascular events, oral anticoagulation initiation, and major bleeding. Multivariable logistic regression and Cox proportional hazards models were used, adjusted for prespecified vascular risk factors.

AF was detected in 36% of participants in the ICM group and 9% in the control group (OR 6.9, 95% CI 3.7-13.5; p < 0.001). No significant differences were observed in recurrent stroke (HR 1.8, 95% CI 0.78-4.36; p = 0.17), mortality (HR 0.88, 95% CI 0.58-1.58; p = 0.88), or the composite outcome (HR 0.96, 95% CI 0.6–1.5; p = 0.85) over a median follow-up of 42 months (IQR 15-66).

Fixed-time analyses showed lower 2-year mortality (OR 0.40, 95% CI 0.16-0.94; p = 0.036) and fewer major bleeding events (OR 0.19, 95% CI 0.06-0.52; p = 0.002) in the ICM group. Age and troponin T were identified as independent predictors of adverse outcomes.

These findings indicate that ICM was associated with higher AF detection in women with cryptogenic stroke, with no significant differences in stroke recurrence and signals of lower mortality and major bleeding at 2 years.