Atrial fibrillation and cryptogenic stroke. What is the current evidence? Role of electrocardiographic monitoring

Puerta, Raimundo Carmona; Torres, Yaniel Castro

doi:10.1002/joa3.12016

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…ICMs should therefore be considered more often in the evaluation of cryptogenic ischaemic events. 5,30,31 Currently only a minority of cryptogenic stroke patients are screened with long-term ECG because this method is still not routinely available in clinical practice due to high costs. 32 Another reason is that the cryptogenic stroke patients group is very heterogenic regarding aetiology and only a minority have cardioembolism due to AF.…”

Section: Discussionmentioning

confidence: 99%

Atrial fibrillation in cryptogenic stroke and transient ischaemic attack – The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study: Rationale and design

Ratajczak-Tretel

Lambert

Johansen

et al. 2019

European Stroke Journal

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Section: Discussionmentioning

confidence: 99%

Atrial fibrillation in cryptogenic stroke and transient ischaemic attack – The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study: Rationale and design

Ratajczak-Tretel

Lambert

Johansen

et al. 2019

European Stroke Journal

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“…In the current study, none of our patients showed heart abnormalities in routine examination, which might be explained by the following reasons. First, in a previous report, only 3% of AF cases were diagnosed using 24-hour ECG in cryptogenic stroke, but the detection rate increased to 30% with 36-month monitoring ( 52 ). Elevated P terminal force v1, a marker of early atrial pathological change, was also related to embolic stroke ( 53 ).…”

Section: Discussionmentioning

confidence: 99%

Monogenic basis of young-onset cryptogenic stroke: a multicenter study

Yuan¹,

Shang²,

Tian³

et al. 2022

Ann Transl Med

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Background The prevalence of stroke in young adults is increasing. We investigated the monogenic basis of young adult cryptogenic stroke patients. Methods This multicenter study enrolled cryptogenic stroke patients under 55 years old, and individuals with nonstroke diseases were included as controls. Targeted next-generation sequencing (NGS) was applied with a custom-designed gene panel that included 551 genes. Rare variants were classified into 2 groups: pathogenic variants and variants of unknown significance. Results A total of 153 individuals, including 30 (21 males, 70%; mean age 36.1±10.2 years) in the disease group and 123 (59 males, 48.0%; mean age 40.4±13.1 years) in the control group, were recruited. In the disease group, 32 rare variants were identified. Among these individuals, 18 pathogenic variants in 16 patients were detected, with a 53.3% (16/30) diagnostic yield of monogenic causes for cryptogenic stroke. None of these mutations were observed in the control group. Among the mutant genes, the most prevalent were Notch receptor 3 ( NOTCH3 ), protein kinase AMP-activated noncatalytic subunit gamma 2 ( PRKAG2 ), and ryanodine receptor 2 ( RYR2 ). Genes associated with cardiogenic diseases showed the highest mutation frequency (10/18, 55.6%) followed by genes associated with small-vessel diseases (SVDs) and coagulation disorders. None of the patients with mutations had evident abnormalities in the heart or other systems checked by routine tests. For the imaging phenotype–genotype association analysis, infarctions in both the anterior and posterior cerebral circulation were only observed in patients with genes related to cardiogenic disease. Conclusions In this study, pathogenic variants were identified in nearly half of the young-onset cryptogenic stroke patients, with genes related to cardiogenic diseases being the most frequently mutated. This may have implications for future clinical decision-making, including the development of finer and more sensitive examinations.

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“…It is desirable that ECG monitoring initiated shortly after ESUS be prolonged, especially in the subpopulation with additional signs of atrial disease [17][18][19][20][21][22]. Supplementary diagnostic procedures should be initiated as soon as possible following the occurrence of stroke, in order to maximise the benefits of potentially indicated anticoagulation.…”

Section: Therapeutic Problemmentioning

confidence: 99%

Statement by a Working Group conceived by the Polish National Consultants in Cardiology and Neurology addressing the use of implantable cardiac monitors in patients after ischaemic embolic stroke of undetermined source

Farkowski

Karliñski

Kaźmierczak

et al. 2018

Neurol Neurochir Pol.

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Introduction. Stroke remains one of the main causes of death and the most common cause of long-term disability in adults. Embolic strokes of undetermined source (ESUS) amount to a significant proportion of all ischaemic strokes. Detection of atrial fibrillation (AF) in this group of patients would allow for a major therapeutic decision to switch from antiplatelets to oral anticoagulants and therefore significantly reduce the risk of recurrence. State of the Art. Current technology allows long-term continuous ECG monitoring with different systems, including implantable cardiac monitors (ICM). However, in Poland lack of reimbursement does not allow their use in everyday clinical practice. Clinical Implications. This is a statement by a Working Group conceived by the Polish National Consultants in Cardiology and Neurology addressing the use of ICM in patients after ischaemic embolic strokes of undetermined source. The aim was to develop reasonable and comprehensive guidance on how to select and manage candidates for ICM in order to obtain the maximum benefit for Polish public health. Future Directions. This expert opinion is not intended as a guideline but it provides advice as to how to optimise the potential use of ICM in patients after ESUS in the Polish setting.

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Atrial fibrillation and cryptogenic stroke. What is the current evidence? Role of electrocardiographic monitoring

Cited by 5 publications

References 19 publications

Atrial fibrillation in cryptogenic stroke and transient ischaemic attack – The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study: Rationale and design

Atrial fibrillation in cryptogenic stroke and transient ischaemic attack – The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study: Rationale and design

Monogenic basis of young-onset cryptogenic stroke: a multicenter study

Statement by a Working Group conceived by the Polish National Consultants in Cardiology and Neurology addressing the use of implantable cardiac monitors in patients after ischaemic embolic stroke of undetermined source

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