Abstract:Atrial fibrillation (AF) is a strong risk factor for first-ever stroke and stroke recurrence. The detection rate is low and detection is often costly and time-consuming. We evaluated the diagnostic yield of an external loop recorder (ELR) in patients with acute ischemic stroke or TIA, and assessed factors that are associated with AF detection. We prospectively studied patients admitted to the stroke unit with ischemic stroke or TIA, without a history of AF, and no AF on routine-ECG and 24-h telemetry. Patients… Show more
“…Twenty-four articles, 16 full manuscripts and 8 abstracts, of 1205 identified citations fulfilled the eligibility criteria (Figure 1). 3,15–37 Three studies (13%) were randomized controlled trials and 21 (87%) were prospective observational (online supplementary Table 2). After seven studies were excluded from the analysis because of missing data, 17 studies were included in the meta-analysis.…”
Section: Resultsmentioning
confidence: 99%
“…Thus, 1423 data sets from 25 cohorts were included in our meta-analysis. 3,16,17,19–24,26–29,31–33,37 Figure 2.Forest plot showing proportion of TIA patients diagnosed with AF in all included cohorts using different modalities of ECG monitoring. ES: effect size, CI: confidence intervals.…”
Section: Resultsmentioning
confidence: 99%
“…In eight studies, TIA patients received prolonged monitoring within the first 72 h after the index event, 3,20,21,24,27–29,37 whereas other studies recruited patients later than 30 days after TIA. 16,17,19,22,23,31 In some studies, monitoring started immediately after admission in an inpatient setting, 3,20,21,24,27–29,33,36,37 whereas patients received a monitor as outpatients in other studies 16–19,22,23,25,26,31,32,34,35 Nevertheless, AF detection is more likely in selected patients with suspected embolism compared to unselected populations. 23,31,47 Older age, certain clinical and neuroimaging findings (e.g.…”
Background and purpose The detection rate of atrial fibrillation has not been studied specifically in transient ischemic attack (TIA) patients although extrapolation from ischemic stroke may be inadequate. We conducted a systematic review and meta-analysis to determine the rate of newly diagnosed atrial fibrillation using different methods of ECG monitoring in TIA. Methods A comprehensive literature search was performed following a pre-specified protocol the PRISMA statement. Prospective observational studies and randomized controlled trials were considered that included TIA patients who underwent cardiac monitoring for >12 h. Primary outcome was frequency of detection of atrial fibrillation ≥30 s. Analyses of subgroups and of duration and type of monitoring were performed. Results Seventeen studies enrolling 1163 patients were included. The pooled atrial fibrillation detection rate for all methods was 4% (95% CI: 2-7%). Yield of monitoring was higher in selected (higher age, more extensive testing for arrhythmias before enrolment, or presumed cardioembolic/cryptogenic cause) than in unselected cohorts (7% vs 3%). Pooled mean atrial fibrillation detection rates rose with duration of monitoring: 4% (24 h), 5% (24 h to 7 days) and 6% (>7 days), respectively. Yield of non-invasive was significantly lower than that of invasive monitoring (4% vs. 11%). Significant heterogeneity was observed among studies (I=60.61%). Conclusion This first meta-analysis of atrial fibrillation detection in TIA patients finds a lower atrial fibrillation detection rate in TIA than reported for IS and TIA cohorts in previous meta-analyses. Prospective studies are needed to determine actual prevalence of atrial fibrillation and optimal diagnostic procedure for atrial fibrillation detection in TIA.
“…Twenty-four articles, 16 full manuscripts and 8 abstracts, of 1205 identified citations fulfilled the eligibility criteria (Figure 1). 3,15–37 Three studies (13%) were randomized controlled trials and 21 (87%) were prospective observational (online supplementary Table 2). After seven studies were excluded from the analysis because of missing data, 17 studies were included in the meta-analysis.…”
Section: Resultsmentioning
confidence: 99%
“…Thus, 1423 data sets from 25 cohorts were included in our meta-analysis. 3,16,17,19–24,26–29,31–33,37 Figure 2.Forest plot showing proportion of TIA patients diagnosed with AF in all included cohorts using different modalities of ECG monitoring. ES: effect size, CI: confidence intervals.…”
Section: Resultsmentioning
confidence: 99%
“…In eight studies, TIA patients received prolonged monitoring within the first 72 h after the index event, 3,20,21,24,27–29,37 whereas other studies recruited patients later than 30 days after TIA. 16,17,19,22,23,31 In some studies, monitoring started immediately after admission in an inpatient setting, 3,20,21,24,27–29,33,36,37 whereas patients received a monitor as outpatients in other studies 16–19,22,23,25,26,31,32,34,35 Nevertheless, AF detection is more likely in selected patients with suspected embolism compared to unselected populations. 23,31,47 Older age, certain clinical and neuroimaging findings (e.g.…”
Background and purpose The detection rate of atrial fibrillation has not been studied specifically in transient ischemic attack (TIA) patients although extrapolation from ischemic stroke may be inadequate. We conducted a systematic review and meta-analysis to determine the rate of newly diagnosed atrial fibrillation using different methods of ECG monitoring in TIA. Methods A comprehensive literature search was performed following a pre-specified protocol the PRISMA statement. Prospective observational studies and randomized controlled trials were considered that included TIA patients who underwent cardiac monitoring for >12 h. Primary outcome was frequency of detection of atrial fibrillation ≥30 s. Analyses of subgroups and of duration and type of monitoring were performed. Results Seventeen studies enrolling 1163 patients were included. The pooled atrial fibrillation detection rate for all methods was 4% (95% CI: 2-7%). Yield of monitoring was higher in selected (higher age, more extensive testing for arrhythmias before enrolment, or presumed cardioembolic/cryptogenic cause) than in unselected cohorts (7% vs 3%). Pooled mean atrial fibrillation detection rates rose with duration of monitoring: 4% (24 h), 5% (24 h to 7 days) and 6% (>7 days), respectively. Yield of non-invasive was significantly lower than that of invasive monitoring (4% vs. 11%). Significant heterogeneity was observed among studies (I=60.61%). Conclusion This first meta-analysis of atrial fibrillation detection in TIA patients finds a lower atrial fibrillation detection rate in TIA than reported for IS and TIA cohorts in previous meta-analyses. Prospective studies are needed to determine actual prevalence of atrial fibrillation and optimal diagnostic procedure for atrial fibrillation detection in TIA.
“…It also records the “event,” which will be further analyzed by the doctor. The proportion of cases of atrial fibrillation identified was from 4.7% to 15.5% [ 63 - 65 ]. Plas and coauthors notedthat the proportion of detected cases of atrial fibrillation was significantly higher if patients with cryptogenic stroke had cortical and subcortical brain lesions reaching17% [ 63 ].…”
Background:
Stroke is a problem worldwide because of its high mortality and disability rates. Almost 90% of strokes are ischemic, and more than half of the deaths are caused by an ischemic stroke. Most risk factors for stroke are manageable so that it can be avoided with proper prevention. Despite the success in determining the causes of stroke in recent years, selectively, the "culprit" causing stroke remains unsolved. In such cases, a diagnosis of undetermined etiology (cryptogenic stroke) or embolic stroke of undetermined source (ESUS) is generated, resulting the prevention of a recurrent cerebrovascular occurrence impossible. Atrial fibrillation (AF) can be a cause of stroke by causing blood clots in the chambers of the heart.
Purpose:
The aim was to determine the optimal method of heart rate monitoring in patients with ischemic stroke, as methods and approaches for detecting AF are very diverse, but there is still no single opinion, which would be universal.
Procedures:
In our review, we consider epidemiology, risk factors for the stroke of undetermined etiology, as well as analytical methods for detecting heart rhythm disturbances in this category of patients.
Findings:
Atrial fibrillation (AF) is detected by thorough monitoring of heart rate of patients with cryptogenic stroke and ESUS can be diagnosed in up to 46% of patients. Conclusion. After AF detection, consideration should be given to prescribing anticoagulants, instead of antiplatelet agents, for the secondary prevention of stroke.
“…B. durch Ausschluss von Dissektionen und passa geren Arrhythmien. Dies ist inzwischen eine Herausforderung, seitdem die Langzeit-EKG Rekorder (Loop Recorder) eine erhebliche Dunkelziffer von in termittierendem Vorhofflimmern gefunden haben [19]. Die PFO Diagnostik spielt für das weitere therapeutische Management vor allem in Hinblick auf die Entscheidung für ein interventio nelles Vorgehen eine Rolle.…”
Section: Indikationen Für Die Rechts-links-shunt Diagnostik ▼unclassified
Zusammenfassung
Bei der Ursachenabkl?rung des isch?mischen Schlaganfalls gerade j?ngerer Patienten wird die ?paradoxe Embolie? ?ber einen Rechts-Links-Shunt als m?glicher Mechanismus diskutiert. Die diagnostischen Ma?nahmen zur Sicherung eines Shunts sollen die Ursache sichern und eine Therapieentscheidung begr?nden helfen. Die trans?sophageale Echokardiografie (TEE) gilt weithin als Standard, weist aber auch Risiken und Fehlbefunde auf. Eine elegante Methode ist die kontrastmittelgest?tzte transkranielle Dopplersonografie (cTCD). Sie ist als Screeningmethode und zur Kontrolle der Behandlungsergebnisse (z.?B. Schirmverschlu?) sehr gut geeignet und erreicht hohe Sensitivit?tswerte.
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