How and When to Screen for Atrial Fibrillation after Stroke: Insights from Insertable Cardiac Monitoring Devices

Bridge, Francesca; Thijs, Vincent

doi:10.5853/jos.2016.00150

Cited by 10 publications

(10 citation statements)

References 60 publications

(89 reference statements)

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“…Consistent with these findings, the American Heart Association recommendations support poststroke cardiac monitoring for up to 30 days [ 34 ]. However, the ideal sequence of technologies and the optimal duration of atrial fibrillation screening remain a matter of intense debate [ 8 , 35 – 43 ].…”

Section: Screening For Atrial Fibrillation Detected After Stroke and mentioning

confidence: 99%

The complexity of atrial fibrillation newly diagnosed after ischemic stroke and transient ischemic attack: advances and uncertainties

Cerasuolo¹,

Cipriano²,

Sposato

2017

Current Opinion in Neurology

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Purpose of reviewAtrial fibrillation is being increasingly diagnosed after ischemic stroke and transient ischemic attack (TIA). Patient characteristics, frequency and duration of paroxysms, and the risk of recurrent ischemic stroke associated with atrial fibrillation detected after stroke and TIA (AFDAS) may differ from atrial fibrillation already known before stroke occurrence. We aim to summarize major recent advances in the field, in the context of prior evidence, and to identify areas of uncertainty to be addressed in future research.Recent findingsHalf of all atrial fibrillations in ischemic stroke and TIA patients are AFDAS, and most of them are asymptomatic. Over 50% of AFDAS paroxysms last less than 30 s. The rapid initiation of cardiac monitoring and its duration are crucial for its timely and effective detection. AFDAS comprises a heterogeneous mix of atrial fibrillation, possibly including cardiogenic and neurogenic types, and a mix of both. Over 25 single markers and at least 10 scores have been proposed as predictors of AFDAS. However, there are considerable inconsistencies across studies. The role of AFDAS burden and its associated risk of stroke recurrence have not yet been investigated.SummaryAFDAS may differ from atrial fibrillation known before stroke in several clinical dimensions, which are important for optimal patient care strategies. Many questions remain unanswered. Neurogenic and cardiogenic AFDAS need to be characterized, as it may be possible to avoid some neurogenic cases by initiating timely preventive treatments. AFDAS burden may differ in ischemic stroke and TIA patients, with distinctive diagnostic and treatment implications. The prognosis of AFDAS and its risk of recurrent stroke are still unknown; therefore, it is uncertain whether AFDAS patients should be treated with oral anticoagulants.

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Section: Screening For Atrial Fibrillation Detected After Stroke and mentioning

confidence: 99%

The complexity of atrial fibrillation newly diagnosed after ischemic stroke and transient ischemic attack: advances and uncertainties

Cerasuolo¹,

Cipriano²,

Sposato

2017

Current Opinion in Neurology

View full text Add to dashboard Cite

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“…Identification at an early stage the diagnosis, the patient's risk factors and comorbid pathology is important for the primary prevention as well as for secondary prevention in order to prevent the development of repeated acute stroke, which often develop in this category of patients [22,23]. Development of individual practical recommendations for the diagnosis and treatment of atrial fibrillation in patients with ischemic heart disease, depending on the presence of comorbidity pathology [24], which is planned in the future, has a promising value in practice.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Comorbidity in Patients With Atrial Fibrillation and Ischemic Heart Disease

Kushnir

2018

EUREKA: Health Sciences

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The aim of the study was to evaluate the risk factors and the incidence of comorbidity in patients with coronary heart disease, depending on the presence of atrial fibrillation. Materials and methods of research: a retrospective analysis of 222 stories of illnesses of patients with coronary heart disease who undergo inpatient treatment, aged from 39 to 88 years, has been conducted. Depending on the presence of atrial fibrillation, all patients were divided into 2 groups: group 1 (main) - patients with ischemic heart disease with atrial fibrillation (n = 105), group 2 (comparison) - patients with ischemic heart disease without atrial fibrillation (n = 117). Results. In the group of patients without AF, the proportion of persons with inherited exacerbations of IHD was 64.29 %, while in the main group - 25.0 %, the differences did not reach the statistically significant level, but this relationship is confirmed by the results of the rank correlation analysis - between the presence AP and heredity revealed a significant weak feedback - c=-0.21 (p<0.05). The diseases that were observed in the examined patients with coronary artery disease present acute violation of cerebral circulation, angina pectoris, acute myocardial infarction, hypertension, diabetes, pathology of the kidneys and the thyroid gland, diastolic dysfunction and obesity. The groups differed in the proportion of patients with stroke - in the group with AF, it was significantly (p=0.002) higher - 23.81 %, in compare to 8.55 % in the comparison group. Conclusions: The presence of atrial fibrillation in patients with coronary heart disease is associated with a high degree of comorbidity. First of all, with the combination of IHD and atrial fibrillation, a high incidence of hypertension, diabetes mellitus, obesity, acute cerebrovascular disorder, kidney disease and thyroid gland is established.

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“…Prolonged ECG recordings identify patients with low AF burden (<1% of the monitoring time) . This type of AF has a low risk of stroke albeit higher than that of patients without AF.…”

Section: What Is the Meaning Of First Episode Of Af After A Cs? Causamentioning

confidence: 99%

“…Further studies are needed to clarify this topic. However, Bridge et al propose the use of intermittent anticoagulation in patients at high risk of bleeding and low AF burden who are also continuously and reliably monitored. In this study, there were no patients with stroke, and bleeding events were manifested only in patients who used continuous anticoagulation.…”

Section: What Is the Meaning Of First Episode Of Af After A Cs? Causamentioning

confidence: 99%

“…9 Prolonged ECG recordings identify patients with low AF burden (<1% of the monitoring time). 10 This type of AF has a low risk of stroke albeit higher than that of patients without AF. In fact, among patients with 2 years of continuous ECG monitoring as little as one hour of AF doubles the risk of ischemic stroke.…”

Section: Episode Of Af After a Cs? Causality Association Or Risk Famentioning

confidence: 99%

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

Puerta¹,

Torres

2017

Journal of Arrhythmia

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The diagnosis of cryptogenic stroke is made by exclusion. However, current evidence supports the role of atrial fibrillation episodes as a cause of this condition. Prospective data have demonstrated the benefits of long‐term electrocardiographic monitoring to identify atrial fibrillation in association with cryptogenic stroke. This aim of this article was to analyze the contemporary evidence for the possible relationship between atrial fibrillation and cryptogenic stroke and the role of continuous electrocardiographic monitoring to clarify this hypothesis.

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How and When to Screen for Atrial Fibrillation after Stroke: Insights from Insertable Cardiac Monitoring Devices

Cited by 10 publications

References 60 publications

The complexity of atrial fibrillation newly diagnosed after ischemic stroke and transient ischemic attack: advances and uncertainties

The complexity of atrial fibrillation newly diagnosed after ischemic stroke and transient ischemic attack: advances and uncertainties

Risk Factors and Comorbidity in Patients With Atrial Fibrillation and Ischemic Heart Disease

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

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