Impact of Atrial Fibrosis Surface Area on the Occurrence of Atrial Fibrillation in Patients With Ischemic Stroke of Undetermined Origin: a Prospective Cardiac MRI Pilot Study.

Phase

N/A

Condition

Cerebral Ischemia

Stroke

Arrhythmia

Treatment

Cardiac MRI (with contrast agent)

Clinical Study ID

NCT06047782

GUENANCIA FRAVC 2022

Ages > 18
All Genders

Study Summary

Atrial fibrillation is a cardiac arrhythmia most often originating in the left atrium, causing anarchic electrical activity and thus a loss of atrial contraction. This increases the risk of stroke through clot formation in the atrium, but also of heart failure. Atrial fibrillation is a major cause of stroke, accounting for more than 25% of all strokes. In addition, a quarter of ischemic strokes remain without an obvious cause at the end of hospitalization, and it is recommended that atrial fibrillation be detected intensively with long-term heart rhythm recording. Implantable loop recorders can detect 30% of atrial fibrillation cases over the 3-year battery life of these devices, after a stroke of undetermined origin. However, these devices require a small operation to implant them under the skin, and they are expensive.

The hypothesis of this study is that MRI imaging of the left atrium would enable better selection of patients to receive an implantable loop recorder. MRI can quantify the proportion of the left atrium with scar tissue, which is likely to favour the onset of atrial fibrillation. If the results confirm this hypothesis, the number of patients requiring an implantable loop recorder could be reduced, and perhaps an anticoagulation strategy based on MRI data could be introduced.

In addition to the usual follow-up by cardiologists and neurologists, participation in this study involves a cardiac MRI (with contrast agent) within 3 months of the stroke.

Eligibility Criteria

Inclusion

Inclusion Criteria:

Patient who has provided free, written and informed consent
Patient of legal age
Patient with cryptogenic ischemic stroke within 30 days of inclusion, documented bybrain imaging (cerebral angioscan or cerebral MRI)
Patients scheduled for implantable loop recorder implantation within 3 months ofischemic stroke in search of silent AF:
cryptogenic ischemic stroke or stroke with probable cardioembolic cause
no history of atrial fibrillation
no long-term anticoagulant therapy
with life expectancy >12 months

Exclusion

Exclusion Criteria:

Person not affiliated to national health insurance
Person under legal protection (curatorship, guardianship)
Person under court order
Pregnant, parturient or breast-feeding
Adult unable to give consent
Patient diagnosed with AF during stroke assessment
Patient with a contraindication to MRI or gadolinium injection:
Severe renal impairment (<30ml/min Cockroft clearance due to gadoliniuminjection)
Claustrophobia / contraindication to MRI (metal implant not MRI compatible)
History of hypersensitivity to gadoteric acid or gadolinium-based contrastagents, and to meglumine
Uncontrolled asthma

Study Design