Lesion Network Mapping for Atrial Fibrillation Newly Detected on ECG or Cardiac Monitoring After Stroke

BACKGROUND: Atrial fibrillation detected after stroke is a distinct clinical entity that may stem from cardiogenic-neurogenic interactions. We aimed to illuminate the lesion network mapping of atrial fibrillation newly detected on ECG or cardiac monitoring after stroke and explore the association between the central autonomic network and occurrence of atrial fibrillation. METHODS: We performed voxel-based lesion-symptom mapping, structural disconnection connectome mapping and functional disconnection connectome mapping to locate lesions and networks for atrial fibrillation newly detected on ECG or cardiac monitoring after stroke. We also calculated the mapping score to quantify the overlap between lesions and maps and evaluated its association with atrial fibrillation using logistic regression analysis. RESULTS: Among 4629 patients, 149 (3.22%) had atrial fibrillation newly detected on ECG or cardiac monitoring after stroke. SDC maps revealed notable disconnections in right insular cortex, amygdala and so on with the peak Z score in the right precentral gyrus (Z score=3.27). Functional disconnection connectome maps revealed pronounced functional disconnections in bilateral precentral/postcentral gyrus, insular cortex and so on with the peak Z score in the right insular cortex (Z score=3.41). Region of interest analysis showed that functional/structural disconnections in some sympathetic/parasympathetic regions (eg, primary motor cortex, temporal pole) were associated with the occurrence of atrial fibrillation. CONCLUSIONS: Significant structural disconnection connectome/functional disconnection connectome mapping and central autonomic network associations were observed in patients with atrial fibrillation newly detected on ECG or cardiac monitoring after stroke, supporting the crucial role of brain networks especially the central autonomic network in the pathogenesis of atrial fibrillation detected after stroke.